ABA Supportive Care Az LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

ABA SUPPORTIVE CARE AZ LLC

Practice address

3623 Crossings Dr Ste 363
Prescott, AZ 86305-7101

Phone

(317) 936-1240

NPI assigned

Apr 25, 2025

Last updated

Apr 25, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ruben Kesherim

Title

President

Phone

(317) 936-1240

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1745539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745539200000",
    "number": "1285422808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3623 CROSSINGS DR STE 363",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 CROSSINGS DR STE 363",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057101",
            "telephone_number": "317-936-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABA SUPPORTIVE CARE AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-25",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A",
        "authorized_official_last_name": "KESHERIM",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-936-1240"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; 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.