Provider Demographics
NPI:1255651022
Name:QUANTUM LEAP FARM, INC.
Entity Type:Organization
Organization Name:QUANTUM LEAP FARM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOPKING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-920-9250
Mailing Address - Street 1:10504 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5017
Mailing Address - Country:US
Mailing Address - Phone:813-920-9250
Mailing Address - Fax:813-920-2124
Practice Address - Street 1:10504 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-5017
Practice Address - Country:US
Practice Address - Phone:813-920-9250
Practice Address - Fax:813-920-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable