NPIMap

Organization Active NPI

Supportive Care ABA VA LLC

  • Community/Behavioral Health Agency
  • McLean, VA
National Provider Identifier
1053034231
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SUPPORTIVE CARE ABA VA LLC
Practice address
1765 Greensboro Station PL
MC Lean, VA 22102-3467
Phone
(317) 936-1240
Fax
(317) 936-1241
NPI assigned
Sep 22, 2022
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ruben Kesherim
Title
Member
Phone
(317) 936-1240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

1765 Greensboro Station PL
MC Lean, VA 22102-3467

Mailing address

1765 Greensboro Station PL
MC Lean, VA 22102-3467
Phone (317) 936-1240

National Provider Directory

National Provider Directory

Locations

1765 Greensboro Station Pl
Mc Lean, VA 22102

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1053034231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 GREENSBORO STATION PL",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023467",
            "telephone_number": "317-936-1240",
            "fax_number": "317-936-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 GREENSBORO STATION PL",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023467",
            "telephone_number": "317-936-1240",
            "fax_number": "317-936-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE ABA VA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "KESHERIM",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "317-936-1240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McLean, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.