Provider Demographics
NPI:1780973123
Name:THE LEARNING GROVE
Entity type:Organization
Organization Name:THE LEARNING GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-399-9199
Mailing Address - Street 1:18631 SHERMAN WAY STE D
Mailing Address - Street 2:18631 SHERMAN WAY STE D
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4162
Mailing Address - Country:US
Mailing Address - Phone:818-399-9199
Mailing Address - Fax:
Practice Address - Street 1:18631 SHERMAN WAY STE D
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4162
Practice Address - Country:US
Practice Address - Phone:818-399-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP15726OtherSTATE LICENCE