Healthcare Provider Details

I. General information

NPI: 1710409982
Provider Name (Legal Business Name): LEAVY HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MASON RUN
PINE HILL NJ
08021
US

IV. Provider business mailing address

906 MASON RUN
PINE HILL NJ
08021
US

V. Phone/Fax

Practice location:
  • Phone: 856-677-6115
  • Fax: 856-258-4550
Mailing address:
  • Phone: 856-677-6115
  • Fax: 856-258-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0257200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number505-427-825-08021
License Number StateNJ

VIII. Authorized Official

Name: MRS. LISA C LEAVY
Title or Position: OWNER
Credential: LEAVY HEALTHCARE SER
Phone: 856-677-6115