Provider Demographics
NPI:1699583310
Name:MIND RISE ABA VA LLC
Entity type:Organization
Organization Name:MIND RISE ABA VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-677-4124
Mailing Address - Street 1:701 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1310
Mailing Address - Country:US
Mailing Address - Phone:732-677-4124
Mailing Address - Fax:
Practice Address - Street 1:2003 PLANK RD # 1028
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5103
Practice Address - Country:US
Practice Address - Phone:732-677-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty