Provider Demographics
NPI:1124768411
Name:BOUNCE ABA LLC
Entity type:Organization
Organization Name:BOUNCE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOVA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-906-6563
Mailing Address - Street 1:400 BOULEVARD OF AMERICAS
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 BOULEVARD OF AMERICAS
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4785
Practice Address - Country:US
Practice Address - Phone:908-906-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health