Healthcare Provider Details

I. General information

NPI: 1285070946
Provider Name (Legal Business Name): FIVE STAR ABA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 CARTWRIGHT WAY
GREENBRIER TN
37073-3516
US

IV. Provider business mailing address

543 CARTWRIGHT WAY
GREENBRIER TN
37073-3516
US

V. Phone/Fax

Practice location:
  • Phone: 877-316-4088
  • Fax: 877-875-2991
Mailing address:
  • Phone: 877-316-4088
  • Fax: 877-875-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN WARNER
Title or Position: OWNER
Credential:
Phone: 877-316-4088