Provider Demographics
NPI:1750844593
Name:MOMENTUM KIDS LLC
Entity Type:Organization
Organization Name:MOMENTUM KIDS LLC
Other - Org Name:MOMENTUM KIDS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIMABEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-490-2450
Mailing Address - Street 1:17595 HARVARD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8522
Mailing Address - Country:US
Mailing Address - Phone:949-490-2450
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4969
Practice Address - Country:US
Practice Address - Phone:949-490-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty