Healthcare Provider Details

I. General information

NPI: 1174029201
Provider Name (Legal Business Name): ABA CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CUMBERLAND PARK DR STE 100
SAINT AUGUSTINE FL
32095-8955
US

IV. Provider business mailing address

23 SOL CT
ST AUGUSTINE FL
32095-8493
US

V. Phone/Fax

Practice location:
  • Phone: 904-201-9129
  • Fax: 615-694-3915
Mailing address:
  • Phone: 904-201-9129
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L STAYTON
Title or Position: OWNER
Credential:
Phone: 904-377-1218