Provider Demographics
NPI:1972850501
Name:LEISURE CARE REFERRAL AGENCY, INC
Entity type:Organization
Organization Name:LEISURE CARE REFERRAL AGENCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACKANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-363-7401
Mailing Address - Street 1:30131 TOWN CENTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR STE 205
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2088
Practice Address - Country:US
Practice Address - Phone:949-363-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care