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Organization

LEAP OF FAITH FAMILY SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MANITA YVETTE JOHNSON (DIRECTOR)
(980) 200-3598
Entity
Organization

Contact information

Practice address
8420 STRIDER DR, CHARLOTTE, NC 28212-1555
(980) 200-3598
Mailing address
8420 STRIDER DR, CHARLOTTE, NC 28212-1555
(980) 200-3598

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
03/08/2011
Last updated
03/08/2011
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