Healthcare Provider Details

I. General information

NPI: 1013700160
Provider Name (Legal Business Name): ABA SUPPORTIVE CARE OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 ENTERPRISE PKWY STE 239
SOLON OH
44139-2755
US

IV. Provider business mailing address

6150 ENTERPRISE PKWY STE 239
SOLON OH
44139-2755
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: PRESIDENT
Credential:
Phone: 317-936-1240