Healthcare Provider Details

I. General information

NPI: 1679078133
Provider Name (Legal Business Name): LEGACY OF JOSH ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SEMORAN COMMERCE PL STE 209
APOPKA FL
32703-4684
US

IV. Provider business mailing address

449 W SILVER STAR RD UNIT 313
OCOEE FL
34761-8013
US

V. Phone/Fax

Practice location:
  • Phone: 407-703-4381
  • Fax:
Mailing address:
  • Phone: 321-914-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SOLFINE DORLEUS
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-703-4381