Provider Demographics
NPI:1952638157
Name:A LEAP OF FAITH OF NC, LLC
Entity Type:Organization
Organization Name:A LEAP OF FAITH OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-548-7460
Mailing Address - Street 1:614 CHIEF MARTIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1684
Mailing Address - Country:US
Mailing Address - Phone:336-548-7460
Mailing Address - Fax:336-548-7461
Practice Address - Street 1:614 CHIEF MARTIN ST STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1684
Practice Address - Country:US
Practice Address - Phone:336-548-7460
Practice Address - Fax:336-548-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4176251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health