Provider Demographics
NPI:1902679772
Name:KIDS CLUB ABA GA LLC
Entity type:Organization
Organization Name:KIDS CLUB ABA GA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-458-0809
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:404-458-0809
Mailing Address - Fax:404-834-5607
Practice Address - Street 1:289 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4805
Practice Address - Country:US
Practice Address - Phone:973-294-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS CLUB ABA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-03
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty