Healthcare Provider Details

I. General information

NPI: 1275659369
Provider Name (Legal Business Name): LEICESTER ELDERLY CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S TURKEY CREEK RD
LEICESTER NC
28748-6500
US

IV. Provider business mailing address

10 S TURKEY CREEK RD
LEICESTER NC
28748-6500
US

V. Phone/Fax

Practice location:
  • Phone: 828-683-4792
  • Fax: 828-683-4792
Mailing address:
  • Phone: 828-683-4792
  • Fax: 828-683-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-011-226
License Number StateNC

VIII. Authorized Official

Name: MRS. LOUISE PONDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 828-683-4792