MEDICARE: ABA BRIGHTWINGS 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	:	1245054303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA BRIGHTWINGS LLC

Provider Business Mailing Address
First Line	:	10163 FORTUNE PKWY # G35
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	305-303-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	10163 FORTUNE PKWY # G35
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	305-303-3236
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VICTOR H MORA
Credential	:	LSW
Telephone Number	:	305-303-3236

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	11/14/2024

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Directions to “ABA BRIGHTWINGS LLC ” Practice Location

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