=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164964524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEADS SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16802 COOK LANDING DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-759-2435
-----------------------------------------------------
Fax | 832-553-3054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16802 COOK LANDING DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-759-2435
-----------------------------------------------------
Fax | 832-553-3054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MR. EYITAYO ADEDOLAPO LAOGUN
-----------------------------------------------------
Credential | MSA
-----------------------------------------------------
Telephone | 832-382-8867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------