Healthcare Provider Details

I. General information

NPI: 1700473006
Provider Name (Legal Business Name): LESLIE'S PERSONAL CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CHERRY ST APT 3
ERIE PA
16502-1740
US

IV. Provider business mailing address

PO BOX 1751
ERIE PA
16512-1751
US

V. Phone/Fax

Practice location:
  • Phone: 814-790-5762
  • Fax:
Mailing address:
  • Phone: 814-790-5762
  • Fax: 814-240-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLIE ELAINE BOOKER
Title or Position: CEO
Credential:
Phone: 814-790-5762