Provider Demographics
NPI:1437881042
Name:BOLD STEPS OF PA LLC
Entity Type:Organization
Organization Name:BOLD STEPS OF PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-686-8292
Mailing Address - Street 1:1642 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2744
Mailing Address - Country:US
Mailing Address - Phone:718-686-8292
Mailing Address - Fax:717-859-5674
Practice Address - Street 1:4755 LINGLESTOWN RD STE 402
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8547
Practice Address - Country:US
Practice Address - Phone:717-341-6004
Practice Address - Fax:717-859-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)