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General NPI Number Information
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NPI Number | 1306305891
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Entity Type | Organization
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Legal Business Name | LEAP OF FAITH ACRES
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 14315 FAMILY TRL
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City | HUDSON
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State | FL
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Zip | 34669-3643
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Country | US
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Telephone | 727-389-3056
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Fax |
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Provider Business Mailing Address
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Address Line | 14315 FAMILY TRL
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City | HUDSON
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State | FL
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Zip | 34669-3643
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Country | US
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Telephone | 727-389-3056
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER SHADE
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Credential |
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Telephone | 727-389-3056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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