Provider Demographics
NPI:1043458383
Name:KOPPER TOP LIFE LEARNING CENTER, INC.
Entity type:Organization
Organization Name:KOPPER TOP LIFE LEARNING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/REC. THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MERIDITH
Authorized Official - Suffix:
Authorized Official - Credentials:LRT/CTRS
Authorized Official - Phone:336-565-9723
Mailing Address - Street 1:6657 KIMESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-9108
Mailing Address - Country:US
Mailing Address - Phone:336-565-9723
Mailing Address - Fax:336-565-0644
Practice Address - Street 1:6657 KIMESVILLE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-9108
Practice Address - Country:US
Practice Address - Phone:336-565-9723
Practice Address - Fax:336-565-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable