Provider Demographics
NPI:1821354408
Name:LEOTILDE ACADEMY MULTI SERVICE INC
Entity Type:Organization
Organization Name:LEOTILDE ACADEMY MULTI SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEOTILDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUERO CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-305-5864
Mailing Address - Street 1:758 BRADY AVE
Mailing Address - Street 2:APT. 411
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2758
Mailing Address - Country:US
Mailing Address - Phone:646-305-5864
Mailing Address - Fax:718-790-9092
Practice Address - Street 1:758 BRADY AVE
Practice Address - Street 2:APT. 411
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2758
Practice Address - Country:US
Practice Address - Phone:646-305-5864
Practice Address - Fax:718-790-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency