Provider Demographics
NPI:1699574830
Name:KIDS CLUB ABA OH LLC
Entity type:Organization
Organization Name:KIDS CLUB ABA OH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-294-8815
Mailing Address - Street 1:17 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-0300
Practice Address - Country:US
Practice Address - Phone:404-458-0809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty