Healthcare Provider Details

I. General information

NPI: 1831436476
Provider Name (Legal Business Name): INSTITUTE FOR THE REDESIGN OF LEARNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 FREMONT AVE
SOUTH PASADENA CA
91030-4507
US

IV. Provider business mailing address

625 FAIR OAKS AVE SUITE200
SOUTH PASADENA CA
91030-2630
US

V. Phone/Fax

Practice location:
  • Phone: 323-341-5580
  • Fax: 323-340-8298
Mailing address:
  • Phone: 323-341-5580
  • Fax: 323-340-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY J LAVELLE
Title or Position: CEO/PRESIDENT
Credential:
Phone: 323-341-5580