| Excellerated Teaching Center, Inc. | |
|
5175 45th St N # 4 St Petersburg FL 33714-2266 | |
| (727) 748-4060 | |
| (727) 748-4060 |
| Full Name | Excellerated Teaching Center, Inc. |
|---|---|
| Speciality | Behavior Analyst |
| Location | 5175 45th St N # 4, St Petersburg, Florida |
| Authorized Official Name and Position | Robert Jones Hasbrouck (OWNER) |
| Authorized Official Contact | 7276861142 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Excellerated Teaching Center, Inc. 5175 45th St N # 4 St Petersburg FL 33714-2266 Ph: (727) 748-4060 | Excellerated Teaching Center, Inc. 5175 45th St N # 4 St Petersburg FL 33714-2266 Ph: (727) 748-4060 |
| NPI Number | 1942626643 |
|---|---|
| Provider Enumeration Date | 03/05/2014 |
| Last Update Date | 06/17/2021 |
| Certification Date | 06/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942626643 | NPI | - | NPPES |
| 022538300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0-13-5494 (Florida) | Primary |
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