Provider Demographics
NPI:1174042220
Name:121 LEARNING WORKS, LLC
Entity Type:Organization
Organization Name:121 LEARNING WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-500-6767
Mailing Address - Street 1:300 CHANGEBRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CHANGEBRIDGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058
Practice Address - Country:US
Practice Address - Phone:973-500-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services