Provider Demographics
NPI:1548618812
Name:BARTLETT LEARNING CENTER - CUPERTINO HOME
Entity Type:Organization
Organization Name:BARTLETT LEARNING CENTER - CUPERTINO HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CILA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-393-7802
Mailing Address - Street 1:3S570 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3S570 WARREN AVE
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3330
Practice Address - Country:US
Practice Address - Phone:630-393-7802
Practice Address - Fax:630-393-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities