=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609245489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDUCATION EXPLOSION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4815 LAVEY LN
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70714-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-308-9565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4815 LAVEY LN
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70714-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHAKESHA SCOTT
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 225-308-9565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | W8A001
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------