Provider Demographics
NPI:1801025259
Name:LEARNING ACHIEVEMENT CENTER
Entity Type:Organization
Organization Name:LEARNING ACHIEVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:731-668-0881
Mailing Address - Street 1:47 MURRAY GUARD DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3765
Mailing Address - Country:US
Mailing Address - Phone:731-668-0881
Mailing Address - Fax:731-668-0884
Practice Address - Street 1:47 MURRAY GUARD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3765
Practice Address - Country:US
Practice Address - Phone:731-668-0881
Practice Address - Fax:731-668-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5514445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty