Provider Demographics
NPI:1235946302
Name:A LEAP OF ABA, LLC
Entity type:Organization
Organization Name:A LEAP OF ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ILUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:470-899-2989
Mailing Address - Street 1:2003 CHEATHAM WOODS DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4451
Mailing Address - Country:US
Mailing Address - Phone:404-594-0519
Mailing Address - Fax:
Practice Address - Street 1:2003 CHEATHAM WOODS DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4451
Practice Address - Country:US
Practice Address - Phone:470-899-2989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service