Provider Demographics
NPI:1093039208
Name:LIBERTY CENTER FOR LANGUAGE AND LEARNING, LLC
Entity Type:Organization
Organization Name:LIBERTY CENTER FOR LANGUAGE AND LEARNING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER, DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GENTEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-991-0877
Mailing Address - Street 1:6791 E ROCK CANYON PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6071
Mailing Address - Country:US
Mailing Address - Phone:529-991-0877
Mailing Address - Fax:
Practice Address - Street 1:6791 E ROCK CANYON PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-6071
Practice Address - Country:US
Practice Address - Phone:529-991-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency