Provider Demographics
NPI:1184903247
Name:LEADERS OF TOMORROW, LLC
Entity type:Organization
Organization Name:LEADERS OF TOMORROW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:563-323-0478
Mailing Address - Street 1:1720 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4812
Mailing Address - Country:US
Mailing Address - Phone:563-323-0478
Mailing Address - Fax:563-324-0308
Practice Address - Street 1:1720 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4812
Practice Address - Country:US
Practice Address - Phone:563-323-0478
Practice Address - Fax:563-324-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAX000402601251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000402601Medicaid