MEDICARE: LEOMAR HEALTH GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103TC0700X	Clinical Psychologist
4	104100000X	Social Worker
5	171M00000X	Case Manager/Care Coordinator
6	251X00000X	Supports Brokerage Agency
7	3747A0650X	Attendant Care Provider
8	3747P1801X	Personal Care Attendant
9	376J00000X	Homemaker
10	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1851175491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEOMAR HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	2888 LOKER AVE E STE 110
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-6683
Country	:	US
Telephone Number	:	888-341-4449
Fax Number	:	858-529-9709

Provider Business Practice Location Address
First Line	:	1201 J ST STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-2949
Country	:	US
Telephone Number	:	888-341-4449
Fax Number	:	858-529-9709

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	MRS. CANDICE SHAMOON
Credential	:
Telephone Number	:	888-341-4449

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/28/2023

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Directions to “LEOMAR HEALTH GROUP INC ” Practice Location

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