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General NPI Number Information
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NPI Number | 1629290721
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Entity Type | Organization
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Legal Business Name | LESLIE FOSTER HOME
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4063 BASEBALL POND ROAD
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City | BROOKSVILLE
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State | FL
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Zip | 34602
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Country | US
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Telephone | 352-544-0337
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Fax | 352-544-0391
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Provider Business Mailing Address
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Address Line | 4063 BASEBALL POND ROAD
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City | BROOKSVILLE
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State | FL
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Zip | 34602
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Country | US
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Telephone | 352-544-0337
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Fax | 352-544-0391
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHERRY LESLIE
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Credential |
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Telephone | 352-544-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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