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General NPI Number Information
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NPI Number | 1790096352
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Entity Type | Organization
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Legal Business Name | LEISON HOMES
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 124 JAMES ST
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City | ALLEGAN
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State | MI
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Zip | 49010-1426
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Country | US
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Telephone | 269-686-1160
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Fax | 269-355-6206
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Provider Business Mailing Address
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Address Line | 124 JAMES ST
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City | ALLEGAN
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State | MI
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Zip | 49010-1426
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Country | US
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Telephone | 269-686-1160
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Fax | 269-355-6206
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Authorized Official
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Title or Position | LICENSEE
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Name | DENA KAY HARRISON
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Credential |
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Telephone | 269-686-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | AF030238133
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License Number State | MI
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