1790729069 NPI number — AUTISM LEARNING CENTER LLC

Table of content: (NPI 1790729069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790729069 NPI number — AUTISM LEARNING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISM 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:
AUTISM LEARNING CENTER
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:
1790729069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 N. 29TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-323-1223
Provider Business Mailing Address Fax Number:
318-323-1224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 N. 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-1223
Provider Business Practice Location Address Fax Number:
318-323-1224
Provider Enumeration Date:
06/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE ADMINISTRATOR
Authorized Official Telephone Number:
318-323-1223

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-08-4659 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 1059396 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 5508 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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