MEDICARE: ABAECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1790444743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABAECARE LLC

Provider Business Mailing Address
First Line	:	1105 W RUSSELL ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-1322
Country	:	US
Telephone Number	:	605-271-2690
Fax Number	:	605-271-3956

Provider Business Practice Location Address
First Line	:	1438 N HIGHWAY 89
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2944
Country	:	US
Telephone Number	:	605-271-2690
Fax Number	:	605-271-3956

Authorized Official
Title or Position	:	DIRECTOR OF CENTRALIZED BUSINESS OF
Name	:	JESSIE FEHRMAN
Credential	:
Telephone Number	:	605-271-2690

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

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Directions to “ABAECARE LLC ” Practice Location

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