Healthcare Provider Details

I. General information

NPI: 1144268681
Provider Name (Legal Business Name): LEE COUNTY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MAIN ST
LEESBURG GA
31763-3712
US

IV. Provider business mailing address

PO BOX 859
LEESBURG GA
31763-0859
US

V. Phone/Fax

Practice location:
  • Phone: 229-759-9236
  • Fax: 229-759-9360
Mailing address:
  • Phone: 229-759-9236
  • Fax: 229-759-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-088-1713
License Number StateGA

VIII. Authorized Official

Name: JOSEPH JOHNSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-759-9236