Provider Demographics
NPI:1609589324
Name:BLUEHAWK CREATIVE LEARNING CENTER, INC.
Entity Type:Organization
Organization Name:BLUEHAWK CREATIVE LEARNING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-333-0475
Mailing Address - Street 1:6910 SILVERHEEL ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-5316
Mailing Address - Country:US
Mailing Address - Phone:913-405-4550
Mailing Address - Fax:
Practice Address - Street 1:6910 SILVERHEEL ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-5316
Practice Address - Country:US
Practice Address - Phone:913-405-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty