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General NPI Number Information
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NPI Number | 1255602215
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Entity Type | Organization
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Legal Business Name | CREATIVE LEARNING INSTITUTE, INC.
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 1702 N WILMINGTON AVE
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City | COMPTON
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State | CA
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Zip | 90222-3419
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Country | US
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Telephone | 310-704-5021
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Fax | 310-438-1707
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Provider Business Mailing Address
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Address Line | 1601 E TUCKER ST
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City | COMPTON
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State | CA
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Zip | 90221-1639
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Country | US
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Telephone | 310-704-5021
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Fax | 310-438-1707
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. GWENDOLYN HAYNES
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Credential |
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Telephone | 310-704-5021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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