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General NPI Number Information
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NPI Number | 1316439508
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Entity Type | Organization
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Legal Business Name | I CAN LIVING & LEARING CENTER
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 2263 NW 2ND AVE STE 207
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City | BOCA RATON
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State | FL
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Zip | 33431-7471
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Country | US
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Telephone | 954-200-0902
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Fax | 561-288-6539
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Provider Business Mailing Address
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Address Line | PO BOX 812753
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City | BOCA RATON
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State | FL
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Zip | 33481-2753
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Country | US
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Telephone | 954-200-0902
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Fax | 561-288-6539
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TANIJA DARINKA CONSTANTARAS
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Credential |
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Telephone | 954-200-0902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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