Provider Demographics
NPI:1609138353
Name:CAROLYN'S UNIQUE LEARNING ACTIVITY CENTER LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CAROLYN'S UNIQUE LEARNING ACTIVITY CENTER LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LIABILITY COMPANY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-664-6900
Mailing Address - Street 1:PO BOX 496732
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-6732
Mailing Address - Country:US
Mailing Address - Phone:214-664-6900
Mailing Address - Fax:886-302-8828
Practice Address - Street 1:3214 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1320
Practice Address - Country:US
Practice Address - Phone:214-664-6900
Practice Address - Fax:866-302-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities