MEDICARE: LESLIE EXCEPTIONAL HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1548752249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE EXCEPTIONAL HOME CARE

Provider Business Mailing Address
First Line	:	6135 JACKSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3636
Country	:	US
Telephone Number	:	267-366-5220
Fax Number	:	215-743-2079

Provider Business Practice Location Address
First Line	:	6135 JACKSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3636
Country	:	US
Telephone Number	:	267-366-5220
Fax Number	:	215-743-2079

Authorized Official
Title or Position	:	CEO
Name	:	LESLIE ROMAN
Credential	:
Telephone Number	:	215-868-8515

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	05/30/2018

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