Organization
ABA SUPPORTIVE CARE AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN KESHERIM (PRESIDENT)
(317) 936-1240
Entity
Organization
Contact information
Practice address
3623 CROSSINGS DR STE 363, PRESCOTT, AZ 86305-7101
(317) 936-1240
Mailing address
3623 CROSSINGS DR STE 363, PRESCOTT, AZ 86305-7101
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/25/2025
Last updated
04/25/2025
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