Provider Demographics
NPI:1346929767
Name:ABA BRIGHTWINGS,LLC
Entity Type:Organization
Organization Name:ABA BRIGHTWINGS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-1189
Mailing Address - Street 1:220 NE 12TH AVE LOT 16
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6228
Mailing Address - Country:US
Mailing Address - Phone:786-306-1189
Mailing Address - Fax:
Practice Address - Street 1:501 E DANIA BEACH BLVD APT 1L
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3010
Practice Address - Country:US
Practice Address - Phone:786-306-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty