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General NPI Number Information
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NPI Number | 1063619724
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Entity Type | Organization
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Legal Business Name | LEISURE HOME LIFE, INC.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 E SAINT JOHN ST
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City | TARBORO
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State | NC
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Zip | 27886-4544
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Country | US
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Telephone | 252-641-4107
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Fax | 252-973-8599
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Provider Business Mailing Address
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Address Line | PO BOX 2087
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City | ROCKY MOUNT
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State | NC
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Zip | 27802-2087
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Country | US
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Telephone | 252-641-4107
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Fax | 252-973-8599
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TEMPSIE D. RICHARDSON
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Credential |
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Telephone | 252-641-4107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-033-003
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License Number State | NC
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