Provider Demographics
NPI:1124807896
Name:MAIDEN'S EMBRACE ABA
Entity type:Organization
Organization Name:MAIDEN'S EMBRACE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:858-253-0809
Mailing Address - Street 1:10985 PACIFIC POINT PL UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2088
Mailing Address - Country:US
Mailing Address - Phone:858-253-0809
Mailing Address - Fax:
Practice Address - Street 1:10985 PACIFIC POINT PL UNIT 1203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2088
Practice Address - Country:US
Practice Address - Phone:858-253-0809
Practice Address - Fax:858-261-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
Yes251V00000XAgenciesVoluntary or Charitable
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)