Provider Demographics
NPI:1841022290
Name:ABA PRIME SERVICES LLC
Entity type:Organization
Organization Name:ABA PRIME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AGNELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTILES NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-691-7202
Mailing Address - Street 1:1412 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-6009
Mailing Address - Country:US
Mailing Address - Phone:239-691-7202
Mailing Address - Fax:
Practice Address - Street 1:1412 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-6009
Practice Address - Country:US
Practice Address - Phone:239-691-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health