MEDICARE: CARDINAL ABA SERVICES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730758277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL ABA SERVICES, LLC

Provider Business Mailing Address
First Line	:	115 KNOLLWOOD WAY
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-6335
Country	:	US
Telephone Number	:	850-803-2562
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 BEAL PKWY SE UNIT 107
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5343
Country	:	US
Telephone Number	:	850-803-2562
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHELE ELIZABETH SAGE
Credential	:	BCBA
Telephone Number	:	850-803-2562

Provider Enumeration Date	:	06/19/2021
Last Update Date	:	08/24/2021

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