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General NPI Number Information
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NPI Number | 1679078133
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Entity Type | Organization
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Legal Business Name | LEGACY OF JOSH ACADEMY
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 380 SEMORAN COMMERCE PL STE 209
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City | APOPKA
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State | FL
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Zip | 32703-4684
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Country | US
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Telephone | 407-703-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 449 W SILVER STAR RD UNIT 313
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City | OCOEE
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State | FL
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Zip | 34761-8013
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Country | US
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Telephone | 321-914-9949
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SOLFINE DORLEUS
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Credential |
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Telephone | 407-703-4381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home 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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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