Healthcare Provider Details

I. General information

NPI: 1366383820
Provider Name (Legal Business Name): JACE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAIN ST STE 201
BLACKSTONE MA
01504-2215
US

IV. Provider business mailing address

61 MAIN ST STE 201
BLACKSTONE MA
01504-2215
US

V. Phone/Fax

Practice location:
  • Phone: 508-565-8645
  • Fax: 508-573-7057
Mailing address:
  • Phone: 508-565-8645
  • Fax: 508-573-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICK INYANGA
Title or Position: NURSE
Credential: RN
Phone: 978-399-5553