=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033650312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCHORABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2017
-----------------------------------------------------
Last Update Date | 03/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 DAISY HILL RD
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06370-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-271-1380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 DAISY HILL RD
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06370-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-271-1380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MORGAN ELAINE CATES
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 410-271-1380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 16-22296
-----------------------------------------------------
License Number State |
-----------------------------------------------------