Healthcare Provider Details

I. General information

NPI: 1114763752
Provider Name (Legal Business Name): ABOVE AND BEYOND MILESTONES DEVELOPMENT CENTER GK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1-796 CHATAN-CHO MIYAGI PORTSIDE TOWN 3A
CHATAN OKINAWA PERFECTURE
9040113
JP

IV. Provider business mailing address

1-796 CHATAN-CHO MIYAGI PORTSIDE TOWN 3A
CHATAN OKINAWA PERFECTURE
9040113
JP

V. Phone/Fax

Practice location:
  • Phone: 708-944-3435
  • 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: LILIT DEJANIRA SALAZAR
Title or Position: CO-CEO
Credential: BCBA
Phone: 818-433-2351