Provider Demographics
NPI:1881958999
Name:EDUCATIONAL ADVANTAGE LLC
Entity type:Organization
Organization Name:EDUCATIONAL ADVANTAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-581-8045
Mailing Address - Street 1:448 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1205
Mailing Address - Country:US
Mailing Address - Phone:909-394-0823
Mailing Address - Fax:909-693-5452
Practice Address - Street 1:448 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1205
Practice Address - Country:US
Practice Address - Phone:909-394-0823
Practice Address - Fax:909-693-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty