Provider Demographics
NPI:1912777616
Name:ABA GRATEFUL CARE AZ LLC
Entity Type:Organization
Organization Name:ABA GRATEFUL CARE AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-285-0113
Mailing Address - Street 1:929 N VAL VISTA DR
Mailing Address - Street 2:STE 109
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:317-572-5315
Mailing Address - Fax:317-588-1693
Practice Address - Street 1:929 N VAL VISTA DR STE 109929 N VAL VISTA DR
Practice Address - Street 2:STE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:317-572-5315
Practice Address - Fax:317-588-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty