Provider Demographics
NPI:1487323812
Name:ALL STARS ABA LLC
Entity type:Organization
Organization Name:ALL STARS ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MYTELKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-621-0070
Mailing Address - Street 1:3 E EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5101
Mailing Address - Country:US
Mailing Address - Phone:845-634-1463
Mailing Address - Fax:
Practice Address - Street 1:7750 OKEECHOBEE BLVD STE 4-418
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2104
Practice Address - Country:US
Practice Address - Phone:845-507-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health