Provider Demographics
NPI:1720342264
Name:MOVING FORWARD LEAPS LLC
Entity type:Organization
Organization Name:MOVING FORWARD LEAPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:917-304-1696
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-0434
Mailing Address - Country:US
Mailing Address - Phone:917-304-1696
Mailing Address - Fax:
Practice Address - Street 1:2837 W 30TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1803
Practice Address - Country:US
Practice Address - Phone:917-304-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty