Healthcare Provider Details

I. General information

NPI: 1245164060
Provider Name (Legal Business Name): OCEAN WAVE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8085 S CHESTER ST
CENTENNIAL CO
80112-3543
US

IV. Provider business mailing address

8085 S CHESTER ST
CENTENNIAL CO
80112-3543
US

V. Phone/Fax

Practice location:
  • Phone: 347-507-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIEZER KLEIN
Title or Position: DIRECTOR
Credential:
Phone: 347-507-8855