Provider Demographics
NPI:1962758961
Name:INTERIM HEALTHCARE OF LEESBURG, LLC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF LEESBURG, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-645-3211
Mailing Address - Street 1:1890 STATE ROAD 436
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2228
Mailing Address - Country:US
Mailing Address - Phone:407-645-3211
Mailing Address - Fax:407-628-2853
Practice Address - Street 1:9738 US HIGHWAY 441
Practice Address - Street 2:SUITE 103
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3974
Practice Address - Country:US
Practice Address - Phone:352-326-0400
Practice Address - Fax:352-365-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20578096251E00000X
FL20575095251E00000X
FL20576096251E00000X
FL20572096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health