Provider Demographics
NPI:1316439508
Name:I CAN LIVING & LEARING CENTER
Entity type:Organization
Organization Name:I CAN LIVING & LEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIJA
Authorized Official - Middle Name:DARINKA
Authorized Official - Last Name:CONSTANTARAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-200-0902
Mailing Address - Street 1:PO BOX 812753
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-2753
Mailing Address - Country:US
Mailing Address - Phone:954-200-0902
Mailing Address - Fax:561-288-6539
Practice Address - Street 1:2263 NW 2ND AVE STE 207
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7471
Practice Address - Country:US
Practice Address - Phone:954-200-0902
Practice Address - Fax:561-288-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities