Provider Demographics
NPI:1669820106
Name:EARLY BIRD'S ABA, LLC
Entity Type:Organization
Organization Name:EARLY BIRD'S ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:770-596-3828
Mailing Address - Street 1:2337 STONE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5717
Mailing Address - Country:US
Mailing Address - Phone:770-596-3828
Mailing Address - Fax:
Practice Address - Street 1:2337 STONE DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5717
Practice Address - Country:US
Practice Address - Phone:770-596-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health