Healthcare Provider Details

I. General information

NPI: 1023920865
Provider Name (Legal Business Name): SUPPORTIVE CARE ABA NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E GRAND AVE STE 156
CLOVIS NM
88101-7549
US

IV. Provider business mailing address

120 E GRAND AVE STE 156
CLOVIS NM
88101-7549
US

V. Phone/Fax

Practice location:
  • Phone: 317-936-1240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUBEN KESHERIM
Title or Position: CEO
Credential:
Phone: 317-936-1240