Provider Demographics
NPI:1366273773
Name:KEYSTONE CARE ABA, LLC
Entity type:Organization
Organization Name:KEYSTONE CARE ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-453-8562
Mailing Address - Street 1:267 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1819
Mailing Address - Country:US
Mailing Address - Phone:570-453-8562
Mailing Address - Fax:
Practice Address - Street 1:267 QUEEN ST
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1819
Practice Address - Country:US
Practice Address - Phone:570-453-8562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty