Provider Demographics
NPI:1780095984
Name:ABA ADULT DAY CARE LLC
Entity type:Organization
Organization Name:ABA ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-277-6889
Mailing Address - Street 1:24574 COLIN KELLY
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1722
Mailing Address - Country:US
Mailing Address - Phone:248-277-6889
Mailing Address - Fax:
Practice Address - Street 1:24574 COLIN KELLY
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1722
Practice Address - Country:US
Practice Address - Phone:248-277-6889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care