Provider Demographics
NPI:1720720832
Name:LEAF BEHAVIOR SUPPORT LLC
Entity Type:Organization
Organization Name:LEAF BEHAVIOR SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PBS-F
Authorized Official - Phone:757-971-1414
Mailing Address - Street 1:3577 BRANNON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6913
Mailing Address - Country:US
Mailing Address - Phone:757-971-1414
Mailing Address - Fax:757-937-0287
Practice Address - Street 1:3577 BRANNON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6913
Practice Address - Country:US
Practice Address - Phone:757-971-1414
Practice Address - Fax:757-937-0287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAF BEHAVIOR SUPPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, ChildGroup - Single Specialty