Provider Demographics
NPI:1275275638
Name:ABA SHINE LLC
Entity Type:Organization
Organization Name:ABA SHINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RACHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-894-5029
Mailing Address - Street 1:44093 S GRIMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6382
Mailing Address - Country:US
Mailing Address - Phone:510-284-7057
Mailing Address - Fax:
Practice Address - Street 1:44093 S GRIMMER BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6382
Practice Address - Country:US
Practice Address - Phone:510-284-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty