Provider Demographics
NPI:1164294690
Name:ELG LEARNING GROUP, LLC
Entity Type:Organization
Organization Name:ELG LEARNING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-397-6902
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-0812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 WOODCOTE DR
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8479
Practice Address - Country:US
Practice Address - Phone:803-397-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency