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General NPI Number Information
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NPI Number | 1336789114
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Entity Type | Individual
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Provider Name | LESLIE ANN COLLINS
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Gender | Female
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 539 N MAIN ST
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City | CONVOY
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State | OH
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Zip | 45832-7737
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Country | US
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Telephone | 419-860-0494
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Fax |
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Provider Business Mailing Address
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Address Line | 13465 CONVOY RD
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City | VAN WERT
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State | OH
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Zip | 45891-8733
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Country | US
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Telephone | 419-860-0494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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