Healthcare Provider Details

I. General information

NPI: 1962411355
Provider Name (Legal Business Name): LESLIE LAKES CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 6TH ST
ARCADIA LA
71001-3109
US

IV. Provider business mailing address

1355 6TH ST
ARCADIA LA
71001-3109
US

V. Phone/Fax

Practice location:
  • Phone: 318-263-9581
  • Fax:
Mailing address:
  • Phone: 318-263-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number859
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAWNE R SMITH
Title or Position: CEO
Credential:
Phone: 318-812-2140