Provider Demographics
NPI:1932341112
Name:PLAY ABA LLC
Entity Type:Organization
Organization Name:PLAY ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-839-6000
Mailing Address - Street 1:600 E BASELINE RD
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1247
Mailing Address - Country:US
Mailing Address - Phone:480-839-6000
Mailing Address - Fax:
Practice Address - Street 1:600 E BASELINE RD
Practice Address - Street 2:SUITE B-6
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1247
Practice Address - Country:US
Practice Address - Phone:480-839-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ935207Medicaid