Provider Demographics
NPI:1508364050
Name:TYLER ROSE ACADEMY OF LEARNING CENTER
Entity Type:Organization
Organization Name:TYLER ROSE ACADEMY OF LEARNING CENTER
Other - Org Name:TYLER ROSE EDUC & BEHAVIOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-696-3500
Mailing Address - Street 1:12959 JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5223
Mailing Address - Country:US
Mailing Address - Phone:586-696-3500
Mailing Address - Fax:
Practice Address - Street 1:12959 JUPITER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5223
Practice Address - Country:US
Practice Address - Phone:586-696-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181075641251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health