Provider Demographics
NPI:1730845405
Name:ABA PEDIATRIC SERVICES LLC
Entity type:Organization
Organization Name:ABA PEDIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OZGUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-804-4268
Mailing Address - Street 1:11133 E MESQUITE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3530
Mailing Address - Country:US
Mailing Address - Phone:631-804-4268
Mailing Address - Fax:
Practice Address - Street 1:11133 E MESQUITE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3530
Practice Address - Country:US
Practice Address - Phone:631-804-4268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty