1144391475 NPI number — ENTERPRISE SPEECH AND LEARNING CENTER, LLC

Table of content: (NPI 1144391475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144391475 NPI number — ENTERPRISE SPEECH AND LEARNING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENTERPRISE SPEECH AND LEARNING CENTER, LLC
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:
ENTERPRISE SPEECH AND LEARNING CENTER, LLC
Provider Other Organization Name Type Code:
4
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:
1144391475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENTERPRISE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36331-0178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-393-7500
Provider Business Mailing Address Fax Number:
334-393-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 RUCKER BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENTERPRISE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36330-3688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-393-5555
Provider Business Practice Location Address Fax Number:
334-308-0060
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYAN
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-393-7500

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  12983 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51521673 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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