Provider Demographics
NPI:1437762945
Name:KJ THERAPEUTIC LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:KJ THERAPEUTIC LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-623-2677
Mailing Address - Street 1:75 NE 132ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4531
Mailing Address - Country:US
Mailing Address - Phone:941-623-2677
Mailing Address - Fax:
Practice Address - Street 1:75 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4531
Practice Address - Country:US
Practice Address - Phone:941-623-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities