Provider Demographics
NPI:1437025657
Name:PRECIOUS J LEAK
Entity type:Organization
Organization Name:PRECIOUS J LEAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-402-4837
Mailing Address - Street 1:1215 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5222
Mailing Address - Country:US
Mailing Address - Phone:980-402-4837
Mailing Address - Fax:
Practice Address - Street 1:20200 ZION AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8546
Practice Address - Country:US
Practice Address - Phone:980-301-2974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty