1154768745 NPI number — CENTER FOR PROGRESSIVE LEARNING INC

Table of content: (NPI 1154768745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154768745 NPI number — CENTER FOR PROGRESSIVE LEARNING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PROGRESSIVE LEARNING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIRST STEP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154768745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 REDLAND CT
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-3264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-581-7800
Provider Business Mailing Address Fax Number:
410-581-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 REDLAND CT
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-581-7800
Provider Business Practice Location Address Fax Number:
410-581-0036
Provider Enumeration Date:
05/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
410-581-7800

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  904911 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H86 . This is a "CAREFIRST BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 422001301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".