MEDICARE: ELITE ABA SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1184354227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE ABA SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	11550 DOMINION WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-8018
Country	:	US
Telephone Number	:	208-921-8693
Fax Number	:

Provider Business Practice Location Address
First Line	:	11550 DOMINION WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-8018
Country	:	US
Telephone Number	:	208-921-8693
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CYRILLA M WATSON
Credential	:	BCBA
Telephone Number	:	208-921-8693

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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Directions to “ELITE ABA SOLUTIONS LLC ” Practice Location

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