MEDICARE: MAIDEN'S EMBRACE ABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1124807896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIDEN'S EMBRACE ABA

Provider Business Mailing Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:	858-261-0057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IFAH S GRADY
Credential	:	BCBA
Telephone Number	:	858-253-0809

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	05/14/2025

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