MEDICARE: DEFINITELY LEARNING CHILDREN PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1386189785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFINITELY LEARNING CHILDREN PROGRAM

Provider Business Mailing Address
First Line	:	3130 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5226
Country	:	US
Telephone Number	:	323-389-8024
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5226
Country	:	US
Telephone Number	:	323-389-8024
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MRS. JACQUELYN THOMPSON
Credential	:
Telephone Number	:	323-423-5106

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/21/2016

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