Healthcare Provider Details

I. General information

NPI: 1962013482
Provider Name (Legal Business Name): LEEKO FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 SIR HENRY RD
ORLANDO FL
32808-3320
US

IV. Provider business mailing address

5861 SIR HENRY RD
ORLANDO FL
32808-3320
US

V. Phone/Fax

Practice location:
  • Phone: 407-781-7804
  • Fax: 888-363-6121
Mailing address:
  • Phone: 407-781-7804
  • Fax: 888-363-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELSA LEWIS-ANDERSON
Title or Position: CEO
Credential:
Phone: 407-781-7804