Provider Demographics
NPI:1073747143
Name:ADVANCES LEARNING CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCES LEARNING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:617-923-7575
Mailing Address - Street 1:85 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4411
Mailing Address - Country:US
Mailing Address - Phone:617-923-7575
Mailing Address - Fax:617-663-6252
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4411
Practice Address - Country:US
Practice Address - Phone:617-923-7575
Practice Address - Fax:617-663-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health