Provider Demographics
NPI:1376926188
Name:LEAPS-ASD LLC
Entity Type:Organization
Organization Name:LEAPS-ASD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-241-4843
Mailing Address - Street 1:1917 SIXTY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1078
Mailing Address - Country:US
Mailing Address - Phone:863-241-4843
Mailing Address - Fax:
Practice Address - Street 1:1917 SIXTY OAKS LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1078
Practice Address - Country:US
Practice Address - Phone:863-241-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-02-0431251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1700216231OtherINDIVIDUAL NPI #