Provider Demographics
NPI:1518402288
Name:LEAP OF FAITH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:LEAP OF FAITH ENTERPRISES, INC.
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-484-5858
Mailing Address - Street 1:4110 LOWER HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-7900
Mailing Address - Country:US
Mailing Address - Phone:260-484-5858
Mailing Address - Fax:260-747-1866
Practice Address - Street 1:4110 LOWER HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-7900
Practice Address - Country:US
Practice Address - Phone:260-484-5858
Practice Address - Fax:260-747-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09-011607-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care