MEDICARE: DISCOVERY ABA IN 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568116549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY ABA IN LLC

Provider Business Mailing Address
First Line	:	945 N CENTRAL AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1604
Country	:	US
Telephone Number	:	704-440-3580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 N GERMAN CHURCH RD
Second Line	:	SUITE 3117
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-8513
Country	:	US
Telephone Number	:	718-736-5689
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MARK ELIAS
Credential	:
Telephone Number	:	718-736-5689

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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