Provider Demographics
NPI:1932574597
Name:BALLSBRIDGE ACADEMY INC BEHAVIOR AND EDUCATION CENTER
Entity Type:Organization
Organization Name:BALLSBRIDGE ACADEMY INC BEHAVIOR AND EDUCATION CENTER
Other - Org Name:BALLSBRIDGE BEHAVIOR AND CONSULTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA 1-05-2148
Authorized Official - Phone:844-427-8834
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012-0628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 ALPINE VILLA DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-1404
Practice Address - Country:US
Practice Address - Phone:888-740-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3831490251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health