MEDICARE: ABA GRATEFUL CARE TN 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	:	1326791369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA GRATEFUL CARE TN LLC

Provider Business Mailing Address
First Line	:	9234 KINGSTON PIKE # 474
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9234 KINGSTON PIKE # 474
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2380
Country	:	US
Telephone Number	:	917-285-0113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REUVEN LEVOVITZ
Credential	:
Telephone Number	:	917-285-0113

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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