Provider Demographics
NPI:1679300487
Name:ADVANCE ABA , LLC
Entity type:Organization
Organization Name:ADVANCE ABA , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDISATAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-402-7418
Mailing Address - Street 1:PO BOX 12279
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-2279
Mailing Address - Country:US
Mailing Address - Phone:517-245-4778
Mailing Address - Fax:517-698-8223
Practice Address - Street 1:2021 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2926
Practice Address - Country:US
Practice Address - Phone:517-245-4778
Practice Address - Fax:517-698-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty