Healthcare Provider Details

I. General information

NPI: 1336392216
Provider Name (Legal Business Name): EARLY CHILDHOOD LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14379 ROUTE 9W
RAVENA NY
12143-3703
US

IV. Provider business mailing address

14379 ROUTE 9W
RAVENA NY
12143-3703
US

V. Phone/Fax

Practice location:
  • Phone: 518-756-3124
  • Fax: 518-756-9476
Mailing address:
  • Phone: 518-756-3124
  • Fax: 518-756-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSED# 010402880287
License Number StateNY

VIII. Authorized Official

Name: MS. APARNA SHENOY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 518-756-3124