MEDICARE: JOHN T. LESLIE, II, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1326346420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN T. LESLIE, II, INC

Provider Business Mailing Address
First Line	:	15110 MINTZ LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1412
Country	:	US
Telephone Number	:	281-591-0915
Fax Number	:	281-591-0921

Provider Business Practice Location Address
First Line	:	15110 MINTZ LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1412
Country	:	US
Telephone Number	:	281-591-0915
Fax Number	:	281-591-0921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SHANNON WADE
Credential	:
Telephone Number	:	281-591-0915

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	10/04/2016

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