Provider Demographics
NPI:1326791369
Name:ABA GRATEFUL CARE TN LLC
Entity Type:Organization
Organization Name:ABA GRATEFUL CARE TN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-285-0113
Mailing Address - Street 1:9234 KINGSTON PIKE # 474
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9234 KINGSTON PIKE # 474
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2380
Practice Address - Country:US
Practice Address - Phone:917-285-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty