Healthcare Provider Details

I. General information

NPI: 1790092708
Provider Name (Legal Business Name): THE COMPREHENSIVE LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JAMES WAY
SOUTHAMPTON PA
18966
US

IV. Provider business mailing address

150 JAMES WAY
SOUTHAMPTON PA
18966
US

V. Phone/Fax

Practice location:
  • Phone: 215-322-7852
  • Fax: 215-322-8856
Mailing address:
  • Phone: 215-322-7852
  • Fax: 215-322-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 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: MRS. AMANDA FLAVELL
Title or Position: DIRECTOR OF EDUCATION
Credential: M.A., BCBA
Phone: 215-322-7852