Provider Demographics
NPI:1912665290
Name:CREATIVE ABA CONNECTIONS, INC
Entity Type:Organization
Organization Name:CREATIVE ABA CONNECTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE INGRASSIA
Authorized Official - Last Name:MOERING
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:321-439-1971
Mailing Address - Street 1:PO BOX 621955
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-1955
Mailing Address - Country:US
Mailing Address - Phone:321-439-1971
Mailing Address - Fax:
Practice Address - Street 1:3809 HOWELL BEND CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8471
Practice Address - Country:US
Practice Address - Phone:321-439-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health