Provider Demographics
NPI:1821615022
Name:LEON ADVOCACY AND RESOURCE CENTER, INC.
Entity Type:Organization
Organization Name:LEON ADVOCACY AND RESOURCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-422-0355
Mailing Address - Street 1:1949 COMMONWEALTH LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3196
Mailing Address - Country:US
Mailing Address - Phone:850-422-0355
Mailing Address - Fax:850-422-0824
Practice Address - Street 1:1949 COMMONWEALTH LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3196
Practice Address - Country:US
Practice Address - Phone:850-422-0355
Practice Address - Fax:850-422-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024300196Medicaid