MEDICARE: LEARY EDUCATIONAL FOUNDATIN, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	493-05-001	VA

General Provider Information

NPI Number	:	1427327790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEARY EDUCATIONAL FOUNDATIN, INC

Provider Business Mailing Address
First Line	:	PO BOX 3160
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22604-2360
Country	:	US
Telephone Number	:	540-888-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1463 NEW HOPE RD
Second Line	:
City	:	CROSS JUNCTION
State	:	VA
Zip	:	22625-2035
Country	:	US
Telephone Number	:	540-888-3456
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN LAMANNA
Credential	:
Telephone Number	:	540-888-3456

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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