1033546213 NPI number — SUPPORTIVE LEARNING CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033546213 NPI number — SUPPORTIVE LEARNING CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPPORTIVE LEARNING CARE
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:
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:
1033546213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N1886 JUNCTION LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-789-0470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N1886 JUNCTION LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54923-8922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-359-5604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BORCHARDT
Authorized Official First Name:
SHANNAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
920-789-0470

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com