Healthcare Provider Details

I. General information

NPI: 1437957149
Provider Name (Legal Business Name): ABA TOTAL CARE NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 SAN PEDRO DR NE STE F10
ALBUQUERQUE NM
87110-4158
US

IV. Provider business mailing address

2315 SAN PEDRO DR NE STE F10
ALBUQUERQUE NM
87110-4158
US

V. Phone/Fax

Practice location:
  • Phone: 404-400-5004
  • Fax:
Mailing address:
  • Phone: 404-400-5004
  • 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

VIII. Authorized Official

Name: RUBEN KESHERIM
Title or Position: PRESIDENT
Credential:
Phone: 404-400-5004