Basic Information
| Provider Information | |||||||||
| NPI: | 1710224365 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INSTITUTE FOR THE REDESIGN OF LEARNING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 FAIR OAKS AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910302630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233415580 | ||||||||
| FaxNumber: | 3233408298 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910304511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233415580 | ||||||||
| FaxNumber: | 3233408298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2013 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | LAVELLE | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3233415580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.