1215697016 NPI number — ABA THERAPY LLC

Table of content: (NPI 1215697016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215697016 NPI number — ABA THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABA THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215697016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 E GRANT ST STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55404-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-249-8907
Provider Business Mailing Address Fax Number:
612-249-8997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E GRANT ST STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-249-8907
Provider Business Practice Location Address Fax Number:
612-249-8997
Provider Enumeration Date:
12/21/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAHAMOUD
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED AGENT
Authorized Official Telephone Number:
612-249-8907

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)