Provider Demographics
NPI:1255577656
Name:SAINT LEO UNIVERSITY
Entity type:Organization
Organization Name:SAINT LEO UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH & WELLNESS CENTE
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:DODEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-588-8347
Mailing Address - Street 1:33701 ST. RD. 52 STE MC2246
Mailing Address - Street 2:
Mailing Address - City:SAINT LEO
Mailing Address - State:FL
Mailing Address - Zip Code:33574
Mailing Address - Country:US
Mailing Address - Phone:352-588-8347
Mailing Address - Fax:352-588-8305
Practice Address - Street 1:33701 ST. RD. 52. STE MC2246
Practice Address - Street 2:
Practice Address - City:SAINT LEO
Practice Address - State:FL
Practice Address - Zip Code:33574
Practice Address - Country:US
Practice Address - Phone:352-588-8347
Practice Address - Fax:352-588-8305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LEO UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81580261QH0100X
FLRN9202490261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service