Provider Demographics
NPI:1407490220
Name:KC LEARNING CENTER, INC
Entity Type:Organization
Organization Name:KC LEARNING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CO-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:WITHERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-243-6840
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-0455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2194
Practice Address - Country:US
Practice Address - Phone:260-243-6840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health