=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295921252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RUBICON SCHOOL AND LEARNING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2007
-----------------------------------------------------
Last Update Date | 10/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 W 2ND ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73003-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-359-1486
-----------------------------------------------------
Fax | 405-359-1499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 729 W 2ND ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73003-5422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-359-1486
-----------------------------------------------------
Fax | 405-359-1499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. PAUL ANTHONY BOER SR.
-----------------------------------------------------
Credential | M.ED.
-----------------------------------------------------
Telephone | 405-359-1486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------