Healthcare Provider Details

I. General information

NPI: 1730774761
Provider Name (Legal Business Name): TOTAL CARE ABA TN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 POPLAR AVE STE 250
MEMPHIS TN
38119-3974
US

IV. Provider business mailing address

148 DOUGHTY BLVD STE 260
INWOOD NY
11096-2047
US

V. Phone/Fax

Practice location:
  • Phone: 516-670-5374
  • Fax:
Mailing address:
  • Phone: 516-670-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RUBEN KESHERIM
Title or Position: FOUNDER
Credential:
Phone: 516-670-5374