Healthcare Provider Details

I. General information

NPI: 1407438302
Provider Name (Legal Business Name): BLUE HEARTS ABA SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 08/18/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 W 116TH AVE
WESTMINSTER CO
80234
US

IV. Provider business mailing address

3758 E 104TH AVE
THORNTON CO
80233-4434
US

V. Phone/Fax

Practice location:
  • Phone: 970-444-2892
  • Fax: 720-863-2064
Mailing address:
  • Phone: 970-444-2892
  • Fax: 720-863-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JEAN CARLOS RICARDO
Title or Position: CEO
Credential: M.S.
Phone: 970-444-2892