Provider Demographics
NPI:1962069286
Name:LEAP CHILD & FAMILY SERVICES LLC
Entity type:Organization
Organization Name:LEAP CHILD & FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATONYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-330-2504
Mailing Address - Street 1:P.O. BOX 34
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013
Mailing Address - Country:US
Mailing Address - Phone:704-500-9511
Mailing Address - Fax:
Practice Address - Street 1:119 NORTH TRADD STREET
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677
Practice Address - Country:US
Practice Address - Phone:980-330-2504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty