Provider Demographics
NPI:1558043109
Name:CHILDREN MAKING STRIDES OF GA LLC
Entity Type:Organization
Organization Name:CHILDREN MAKING STRIDES OF GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FISKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-661-9434
Mailing Address - Street 1:504 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1467
Mailing Address - Country:US
Mailing Address - Phone:678-661-9434
Mailing Address - Fax:
Practice Address - Street 1:3343 PEACHTREE RD NE
Practice Address - Street 2:STE 145-2576
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1085
Practice Address - Country:US
Practice Address - Phone:678-661-9434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty