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General NPI Number Information
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NPI Number | 1588256713
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Entity Type | Organization
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Legal Business Name | SOUTH STAR ABA LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 1526 E 122ND ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-6804
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Country | US
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Telephone | 651-707-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 1526 E 122ND ST
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City | BURNSVILLE
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State | MN
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Zip | 55337-6804
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Country | US
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Telephone | 651-707-6001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CABDI GACAL
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Credential |
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Telephone | 651-707-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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