Provider Demographics
NPI:1912325077
Name:LEAP HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:LEAP HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-614-3234
Mailing Address - Street 1:130 N BROADWAY
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1122
Mailing Address - Country:US
Mailing Address - Phone:856-614-5600
Mailing Address - Fax:
Practice Address - Street 1:130 N BROADWAY
Practice Address - Street 2:10TH FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1122
Practice Address - Country:US
Practice Address - Phone:856-614-5610
Practice Address - Fax:856-614-3236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAP ACADEMY UNIVERSITY CHARTER SCHOOL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-04
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06603200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty