Provider Demographics
NPI:1477130425
Name:ACHIEVE BEHAVIOR ALLIANCE PLUS, LLC
Entity Type:Organization
Organization Name:ACHIEVE BEHAVIOR ALLIANCE PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:317-494-8583
Mailing Address - Street 1:1217 OLD VINES TRL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3412
Mailing Address - Country:US
Mailing Address - Phone:317-494-8583
Mailing Address - Fax:
Practice Address - Street 1:1217 OLD VINES TRL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3412
Practice Address - Country:US
Practice Address - Phone:317-494-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300056345Medicaid