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General NPI Number Information
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NPI Number | 1336755917
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Entity Type | Organization
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Legal Business Name | LEAP OF FAITH ADULT SERVICES LLC
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Dates
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Enumeration Date | 09/19/2020
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 528 VIRGINIA AVE
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City | PETERSBURG
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State | VA
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Zip | 23803-5759
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Country | US
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Telephone | 804-605-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 4409 TEAL CIR
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-6882
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Country | US
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Telephone | 804-926-3744
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR/QDDP/OWNER
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Name | MRS. JESSICA WILLIAMS BOOKER
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Credential | RN,BSN
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Telephone | 804-605-7883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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