Healthcare Provider Details

I. General information

NPI: 1326855446
Provider Name (Legal Business Name): AADVANCED ABA THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S COLORADO BLVD PH
DENVER CO
80246-1904
US

IV. Provider business mailing address

12 AVALON LN
JACKSON NJ
08527-3114
US

V. Phone/Fax

Practice location:
  • Phone: 347-372-4521
  • Fax:
Mailing address:
  • Phone: 848-240-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL ENGLARD
Title or Position: CEO
Credential:
Phone: 347-372-4521