Provider Demographics
NPI:1932410487
Name:EARLY LEARNING INNOVATIONS, LLC
Entity Type:Organization
Organization Name:EARLY LEARNING INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY LEARNING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SATORI
Authorized Official - Last Name:JOBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCPS
Authorized Official - Phone:918-441-3468
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:OK
Mailing Address - Zip Code:74469-0062
Mailing Address - Country:US
Mailing Address - Phone:918-441-3468
Mailing Address - Fax:
Practice Address - Street 1:101 S. GIBSON
Practice Address - Street 2:
Practice Address - City:WEBBERS FALLS
Practice Address - State:OK
Practice Address - Zip Code:74470-0062
Practice Address - Country:US
Practice Address - Phone:918-441-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK103K00000XMedicaid
OK174H00000XMedicaid
OK222Q00000XMedicaid