Healthcare Provider Details

I. General information

NPI: 1801405642
Provider Name (Legal Business Name): UNITED EARLY LEARNING & FAMILY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N ELM ST
GRANDVIEW WA
98930-1009
US

IV. Provider business mailing address

1431 GRANDVIEW PAVEMENT RD
GRANDVIEW WA
98930-9234
US

V. Phone/Fax

Practice location:
  • Phone: 509-402-9090
  • Fax:
Mailing address:
  • Phone: 509-305-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. HUMBERTO C RODRIGUEZ
Title or Position: FOUNDER
Credential:
Phone: 509-305-1542