Provider Demographics
NPI:1871209718
Name:GOLD STAR ABA SERVICES LLC
Entity type:Organization
Organization Name:GOLD STAR ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPO AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-440-7162
Mailing Address - Street 1:26210 PARKER AVE STE 1102
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3864
Mailing Address - Country:US
Mailing Address - Phone:305-440-7162
Mailing Address - Fax:
Practice Address - Street 1:26210 PARKER AVE STE 1102
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3864
Practice Address - Country:US
Practice Address - Phone:305-440-7162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty