Provider Demographics
NPI:1386886901
Name:LEISURE CITY HOME CARE
Entity type:Organization
Organization Name:LEISURE CITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-277-1226
Mailing Address - Street 1:14785 COOLIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2710
Mailing Address - Country:US
Mailing Address - Phone:786-277-1226
Mailing Address - Fax:305-554-9345
Practice Address - Street 1:14785 COOLIDGE LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2710
Practice Address - Country:US
Practice Address - Phone:786-277-1226
Practice Address - Fax:305-554-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11541310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility