1164621538 NPI number — THE LEARNING TREE INTERGENERATIONAL CENTER INC

Table of content: (NPI 1164621538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164621538 NPI number — THE LEARNING TREE INTERGENERATIONAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LEARNING TREE INTERGENERATIONAL CENTER 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:
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:
1164621538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4430 LABADIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-534-0699
Provider Business Mailing Address Fax Number:
314-534-4575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4430 LABADIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-534-0699
Provider Business Practice Location Address Fax Number:
314-534-4575
Provider Enumeration Date:
07/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
CO FOUNDER EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
314-534-0699

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  686 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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