Healthcare Provider Details

I. General information

NPI: 1043965346
Provider Name (Legal Business Name): ELITE ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 SW 183RD TERRACE
MIRAMAR FL
33029
US

IV. Provider business mailing address

2306 SW 183RD TERRACE
MIRAMAR FL
33029
US

V. Phone/Fax

Practice location:
  • Phone: 786-848-4047
  • Fax: 754-263-5921
Mailing address:
  • Phone: 786-848-4047
  • Fax: 754-263-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L JONES
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: MA, BCBA
Phone: 786-848-4047