MEDICARE: LEEMAN'S PERSONAL CARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	ME
2	372600000X	Adult Companion	ME
3	374700000X	Technician	ME
4	3747A0650X	Attendant Care Provider	ME
5	376J00000X	Homemaker	ME
6	3747P1801X	Personal Care Attendant	ME

General Provider Information

NPI Number	:	1225469737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEEMAN'S PERSONAL CARE AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 91
Second Line	:
City	:	NEW VINEYARD
State	:	ME
Zip	:	04956-0091
Country	:	US
Telephone Number	:	207-650-7793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 NEW VINEYARD RD
Second Line	:
City	:	NEW VINEYARD
State	:	ME
Zip	:	04956-0091
Country	:	US
Telephone Number	:	207-650-7793
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSS,CRMA,MHSS,LTCFL
Name	:	LOIS LEEMAN
Credential	:	PSS, CRMA, MHSS
Telephone Number	:	207-650-7793

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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