Healthcare Provider Details

I. General information

NPI: 1184919227
Provider Name (Legal Business Name): A.G.E.S. LEARNING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/21/2024
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 W HEDDING ST STE 201
SAN JOSE CA
95128-1428
US

IV. Provider business mailing address

2007 W HEDDING ST STE 201
SAN JOSE CA
95128-1428
US

V. Phone/Fax

Practice location:
  • Phone: 866-375-2437
  • Fax: 866-375-2437
Mailing address:
  • Phone: 866-375-2437
  • Fax: 866-375-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1095003
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMYLOU SANTOS
Title or Position: CBO
Credential: BCBA,LBA
Phone: 866-375-2437