=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821615022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEON ADVOCACY AND RESOURCE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2020
-----------------------------------------------------
Last Update Date | 07/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1949 COMMONWEALTH LN
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32303-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-422-0355
-----------------------------------------------------
Fax | 850-422-0824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1949 COMMONWEALTH LN
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32303-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-422-0355
-----------------------------------------------------
Fax | 850-422-0824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PHILLIP K HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-422-0355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------