Basic Information
| Provider Information | |||||||||
| NPI: | 1003366154 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABRITE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 749 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950625124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443347021 | ||||||||
| FaxNumber: | 8883347021 | ||||||||
| Practice Location | |||||||||
| Address1: | 749 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950625124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443347021 | ||||||||
| FaxNumber: | 8883347021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2016 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | FREDERICK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ADMIN AND FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8314546762 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-15-19102 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.