Provider Demographics
NPI:1669040366
Name:EXCELLERATED TEACHING CENTER
Entity Type:Organization
Organization Name:EXCELLERATED TEACHING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:HASBROUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-748-4060
Mailing Address - Street 1:5175 45TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2266
Mailing Address - Country:US
Mailing Address - Phone:727-748-4060
Mailing Address - Fax:727-748-4060
Practice Address - Street 1:5175 45TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2266
Practice Address - Country:US
Practice Address - Phone:727-748-4060
Practice Address - Fax:727-748-4060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELLERATED TEACHING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty