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General NPI Number Information
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NPI Number | 1609211309
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Entity Type | Organization
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Legal Business Name | L & J HOMES, INC.
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 803 ELIZABETH STREET
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City | BURLINGTON
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State | NC
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Zip | 27217-2545
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Country | US
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Telephone | 336-227-5593
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Fax | 336-227-3288
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Provider Business Mailing Address
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Address Line | P.O. BOX 2273 1355 N. CHURCH STREET
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City | BURLINGTON
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State | NC
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Zip | 27217-2803
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Country | US
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Telephone | 336-227-8030
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Fax | 336-227-3288
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Authorized Official
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Title or Position | CEO
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Name | MR. LARRY ALVIN LEATH
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Credential |
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Telephone | 336-227-8030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL001073
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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