Organization
LILLYES HEART
Active
Other names
LeAndra E. Stafford
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEANDRA E STAFFORD (OWNER/CEO)
(904) 722-3301
Entity
Organization
Contact information
Practice address
8387 CENTURY POINT DR N, JACKSONVILLE, FL 32216-9286
(904) 722-3301
(904) 722-3302
Mailing address
8387 CENTURY POINT DR N, JACKSONVILLE, FL 32216-9286
(904) 722-3301
(904) 722-3302
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
689238896
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
689238896
—
FL
05
—
689238898
—
FL
Enumeration date
04/21/2008
Last updated
04/21/2008
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