Provider Demographics
NPI:1598442428
Name:RAD ABA LLC
Entity Type:Organization
Organization Name:RAD ABA LLC
Other - Org Name:RAD ABA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTELOGLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-916-1574
Mailing Address - Street 1:1204 E BASELINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1447
Mailing Address - Country:US
Mailing Address - Phone:480-916-1574
Mailing Address - Fax:
Practice Address - Street 1:1204 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1447
Practice Address - Country:US
Practice Address - Phone:480-916-1574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAD ABA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-03
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty