Provider Demographics
NPI:1114763752
Name:ABOVE AND BEYOND MILESTONES DEVELOPMENT CENTER GK LLC
Entity type:Organization
Organization Name:ABOVE AND BEYOND MILESTONES DEVELOPMENT CENTER GK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIT
Authorized Official - Middle Name:DEJANIRA
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:818-433-2351
Mailing Address - Street 1:1-796 CHATAN-CHO MIYAGI
Mailing Address - Street 2:PORTSIDE TOWN 3A
Mailing Address - City:CHATAN
Mailing Address - State:OKINAWA PERFECTURE
Mailing Address - Zip Code:9040113
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1-796 CHATAN-CHO MIYAGI
Practice Address - Street 2:PORTSIDE TOWN 3A
Practice Address - City:CHATAN
Practice Address - State:OKINAWA PERFECTURE
Practice Address - Zip Code:9040113
Practice Address - Country:JP
Practice Address - Phone:708-944-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty