Healthcare Provider Details

I. General information

NPI: 1255848255
Provider Name (Legal Business Name): VILLAGE LEARNING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N CANON DR
BEVERLY HILLS CA
90210-3326
US

IV. Provider business mailing address

9461 CHARLEVILLE BLVD STE 740
BEVERLY HILLS CA
90212-3017
US

V. Phone/Fax

Practice location:
  • Phone: 646-354-0970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT WILSON
Title or Position: FOUNDER
Credential:
Phone: 734-657-5446