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General NPI Number Information
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NPI Number | 1043406002
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Entity Type | Organization
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Legal Business Name | LEAK'S FAMILY CARE HOME
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 548 COX MADDOX RD
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City | SANFORD
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State | NC
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Zip | 27332-8019
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Country | US
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Telephone | 919-258-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 811 HILLWOOD ST
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City | SANFORD
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State | NC
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Zip | 27330-5530
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Country | US
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Telephone | 919-774-6662
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRINFORD LEAK SR.
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Credential |
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Telephone | 919-774-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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