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General NPI Number Information
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NPI Number | 1114276284
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Entity Type | Organization
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Legal Business Name | THE ERA BURGAN LEARNING CENTER, INC.
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 5451 OLD BETHEL RD
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City | CRESTVIEW
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State | FL
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Zip | 32536-5114
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Country | US
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Telephone | 850-689-3663
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Fax | 850-689-5469
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Provider Business Mailing Address
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Address Line | 5451 OLD BETHEL RD
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City | CRESTVIEW
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State | FL
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Zip | 32536-5114
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Country | US
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Telephone | 850-689-3663
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Fax | 850-689-5469
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MELISSA WOOLLUMS
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Credential |
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Telephone | 850-689-3663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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