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1285394601 NPI number — CANVAS ABA, LLC

NPI Number: 1285394601
Health Care Provider/Practitioner: CANVAS ABA, LLC

Information about “1285394601” NPI (CANVAS ABA, LLC) exists in 1285394601 in HTML format HTML  |  1285394601 in plain Text format TXT  |  1285394601 in PDF (Portable Document Format) PDF  |  1285394601 in an XML format XML  formats.

NPI Number : 1285394601 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285394601",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CANVAS ABA, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "770 HIGHLANDS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAMPSTEAD",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28443-7438",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14886 US HIGHWAY 17",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAMPSTEAD",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28443-3217",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-746-7187",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/27/2021",
    "LastUpdateDate": "12/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ZAMBRON",
    "AuthorizedOfficialFirstName": "KAYLA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.A., BCBA, LBA",
    "AuthorizedOfficialTelephoneNumber": "910-746-7187",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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