MEDICARE: ESSENTIAL LEARNING CENTRE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992529242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL LEARNING CENTRE

Provider Business Mailing Address
First Line	:	995 S ROCK ISLAND RD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2313
Country	:	US
Telephone Number	:	914-906-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	995 S ROCK ISLAND RD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2313
Country	:	US
Telephone Number	:	914-906-4551
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NINA GREEN
Credential	:
Telephone Number	:	914-906-4551

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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Directions to “ESSENTIAL LEARNING CENTRE ” Practice Location

Language	Start Address	Practice Location

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