1689723595 NPI number — CHILDRENS LEARNING CONNECTION, LLC

Table of content: (NPI 1689723595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689723595 NPI number — CHILDRENS LEARNING CONNECTION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS LEARNING CONNECTION, 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:
Provider Other Organization Name Type Code:
6
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:
1689723595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 N. BRAND BLVD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-295-3276
Provider Business Mailing Address Fax Number:
818-241-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5312 BOLSA AVE.
Provider Second Line Business Practice Location Address:
STE. # 105
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6780
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WINTER
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF EXECUTIVE OFFICER
Authorized Official Telephone Number:
818-241-6780

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  BCBA 1-07-3352 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: BCBA 1-09-5316 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-09-5375 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: BCBA 1-03-1209 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: PT 36283 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: PT 37480 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 8264 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 11533 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP 11693 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP 15824 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP 15812 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP 14005 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP 10842 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP12005 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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