MEDICARE: LEEDA NORTHEAST, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	261QA0600X	Adult Day Care Clinic/Center
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	343900000X	Non-emergency Medical Transport (VAN)
5	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255959557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEEDA NORTHEAST, INC.

Provider Business Mailing Address
First Line	:	1441 PARKMAN RD NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2156
Country	:	US
Telephone Number	:	330-392-6006
Fax Number	:	330-392-6116

Provider Business Practice Location Address
First Line	:	1441 PARKMAN RD NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2156
Country	:	US
Telephone Number	:	330-392-6006
Fax Number	:	330-392-6116

Authorized Official
Title or Position	:	ADMINISTRATOR DESIGNEE
Name	:	MEGAN SWEENEY
Credential	:
Telephone Number	:	330-392-6006

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	09/22/2020

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