MEDICARE: ABA SUPPORTIVE CARE SC 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	:	1669320008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA SUPPORTIVE CARE SC LLC

Provider Business Mailing Address
First Line	:	3100 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7286
Country	:	US
Telephone Number	:	317-936-1240
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUBEN KESHERIM
Credential	:
Telephone Number	:	317-936-1240

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

Similar Medicare Providers

1326994534 — AUDIOLOGY SERVICES COMPANY USA, LLC
Practice Location Address:

3100 DICK POND RD UNIT B
MYRTLE BEACH, SC
29588-7286

Practice Phone: 843-294-1900
Practice Fax:

1184924920 — ACCUQUEST HEARING CENTER, LLC
Practice Location Address:

3100 DICK POND RD UNIT B
MYRTLE BEACH, SC
29588-7286

Practice Phone: 843-294-1900
Practice Fax:

1295134856 — MEGAN NOLASCO
Practice Location Address:

3100 DICK POND RD UNIT A
MYRTLE BEACH, SC
29588-7286

Practice Phone: 910-580-9164
Practice Fax: 843-294-0318

1336547694 — PATRICK VUICH H.A.S.
Practice Location Address:

3100 DICK POND RD UNIT B
MYRTLE BEACH, SC
29588-7286

Practice Phone: 843-294-1900
Practice Fax:

1063805414 — MRS. ELIZABETH ANN MINNICH LCMHC, LCAS
Practice Location Address:

3100 DICK POND RD STE E-3
MYRTLE BEACH, SC
29588-7286

Practice Phone: 919-637-9418
Practice Fax:

1083073274 — MS. ANEDRA CHINA ADC, LPC
Practice Location Address:

3100 DICK POND RD STE E
MYRTLE BEACH, SC
29588-7286

Practice Phone: 803-470-3866
Practice Fax: 803-373-1541

Directions to “ABA SUPPORTIVE CARE SC LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.