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General NPI Number Information
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NPI Number | 1164264669
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Entity Type | Organization
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Legal Business Name | BOLD ARROW CO LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 720 S COLORADO BLVD PH NORTH
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City | DENVER
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State | CO
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Zip | 80246-1904
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Country | US
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Telephone | 845-579-0060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | TALLMAN
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State | NY
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Zip | 10982-0459
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Country | US
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Telephone | 845-579-0060
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YITZCHAK LUBART
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Credential |
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Telephone | 845-579-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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