MEDICARE: REGIONAL ENRICHMENT & LEARNING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194008052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL ENRICHMENT & LEARNING CENTER, LLC

Provider Business Mailing Address
First Line	:	1371 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	856-232-7325
Fax Number	:	856-232-7391

Provider Business Practice Location Address
First Line	:	1371 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	856-232-7325
Fax Number	:	856-232-7391

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. DAVID HANDELMAN
Credential	:	ED.D.
Telephone Number	:	856-232-7325

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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