Provider Demographics
NPI:1962013482
Name:LEEKO FAMILY CARE HOME
Entity type:Organization
Organization Name:LEEKO FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-781-7804
Mailing Address - Street 1:5861 SIR HENRY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3320
Mailing Address - Country:US
Mailing Address - Phone:407-781-7804
Mailing Address - Fax:888-363-6121
Practice Address - Street 1:5861 SIR HENRY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3320
Practice Address - Country:US
Practice Address - Phone:407-781-7804
Practice Address - Fax:888-363-6121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCOLADE HEALTH CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-10
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013468000Medicaid