Provider Demographics
NPI:1366224024
Name:ABA WELLNESS AND RECOVERY LLC
Entity type:Organization
Organization Name:ABA WELLNESS AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANBAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRIR
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:206-816-2240
Mailing Address - Street 1:5345 E VAN BUREN ST UNIT 346
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7961
Mailing Address - Country:US
Mailing Address - Phone:206-816-2240
Mailing Address - Fax:
Practice Address - Street 1:5345 E VAN BUREN ST UNIT 346
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7961
Practice Address - Country:US
Practice Address - Phone:206-816-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service