Provider Demographics
NPI:1689266678
Name:SUPERHERO KIDDOS - ABA CENTER
Entity Type:Organization
Organization Name:SUPERHERO KIDDOS - ABA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LINETH
Authorized Official - Last Name:DASILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-458-3836
Mailing Address - Street 1:1401 NE 155TH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5623
Mailing Address - Country:US
Mailing Address - Phone:786-458-3836
Mailing Address - Fax:
Practice Address - Street 1:1401 NE 155TH TER
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-5623
Practice Address - Country:US
Practice Address - Phone:786-458-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency