Healthcare Provider Details

I. General information

NPI: 1437762945
Provider Name (Legal Business Name): KJ THERAPEUTIC LEARNING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NE 132ND ST
NORTH MIAMI FL
33161-4531
US

IV. Provider business mailing address

75 NE 132ND ST
NORTH MIAMI FL
33161-4531
US

V. Phone/Fax

Practice location:
  • Phone: 941-623-2677
  • Fax:
Mailing address:
  • Phone: 941-623-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE SAINT CHARLES
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-623-2677