Provider Demographics
| NPI: | 1174154736 |
|---|---|
| Name: | INDIVIDUALIZED LEARNING CENTERS LLC |
| Entity type: | Organization |
| Organization Name: | INDIVIDUALIZED LEARNING CENTERS LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR/OWNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | TERESA |
| Authorized Official - Middle Name: | DAWN |
| Authorized Official - Last Name: | SIMKINS-ARIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | EDD |
| Authorized Official - Phone: | 602-237-5575 |
| Mailing Address - Street 1: | 2627 E THOMAS RD STE 100 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85016-8231 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-237-5575 |
| Mailing Address - Fax: | 602-237-5996 |
| Practice Address - Street 1: | 2627 E THOMAS RD STE 100 |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85016-8231 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-237-5575 |
| Practice Address - Fax: | 602-237-5996 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | INDIVIDUALIZED LEARNING CENTERS LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2020-01-31 |
| Last Update Date: | 2021-08-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251300000X | Agencies | Local Education Agency (LEA) | ||
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | ||
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | ||
| No | 385H00000X | Respite Care Facility | Respite Care | ||
| No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp | |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 524491 | Other | STRUCTURED ENGLISH IMMERSION |
