Healthcare Provider Details

I. General information

NPI: 1972850501
Provider Name (Legal Business Name): LEISURE CARE REFERRAL AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30131 TOWN CENTER DR STE 205
LAGUNA NIGUEL CA
92677-2088
US

IV. Provider business mailing address

30131 TOWN CENTER DR STE 205
LAGUNA NIGUEL CA
92677-2088
US

V. Phone/Fax

Practice location:
  • Phone: 949-363-7401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. TREVOR L BLACKANN
Title or Position: PRESIDENT
Credential:
Phone: 949-363-7401