Healthcare Provider Details

I. General information

NPI: 1669220364
Provider Name (Legal Business Name): LEAP OF FAITH MINISTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 BURKE AVE
BRONX NY
10469-5023
US

IV. Provider business mailing address

5951 RIVERDALE AVE UNIT 1225
BRONX NY
10471-4327
US

V. Phone/Fax

Practice location:
  • Phone: 803-306-0623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: IMANI WILFORM
Title or Position: OWNER
Credential:
Phone: 803-306-0623