Healthcare Provider Details

I. General information

NPI: 1164337069
Provider Name (Legal Business Name): BRIGHT HARBOR SERVICE, LLC D/B/A ABLE AUTISM THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 ROSWELL RD STE 100&103
SANDY SPRINGS GA
30350-7024
US

IV. Provider business mailing address

8010 ROSWELL RD STE 100&103
SANDY SPRINGS GA
30350-7024
US

V. Phone/Fax

Practice location:
  • Phone: 470-281-2363
  • Fax: 470-239-2747
Mailing address:
  • Phone: 470-281-2363
  • Fax: 470-239-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. SANDEEP KANAWADE
Title or Position: CEO
Credential:
Phone: 954-706-7676