Provider Demographics
NPI:1164264669
Name:BOLD ARROW CO LLC
Entity type:Organization
Organization Name:BOLD ARROW CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-579-0060
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0459
Mailing Address - Country:US
Mailing Address - Phone:845-579-0060
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD PH NORTH
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:845-579-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty