Healthcare Provider Details

I. General information

NPI: 1821440892
Provider Name (Legal Business Name): ABA THERAPY 4KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 SEMINOLA BLVD UNIT 116
CASSELBERRY FL
32707-3642
US

IV. Provider business mailing address

1544 SEMINOLA BLVD UNIT 116
CASSELBERRY FL
32707-3642
US

V. Phone/Fax

Practice location:
  • Phone: 786-261-5601
  • Fax:
Mailing address:
  • Phone: 407-636-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISABET NAVARRO
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 786-261-5601