Provider Demographics
NPI:1992873087
Name:JAMES-LEACH,INC.
Entity type:Organization
Organization Name:JAMES-LEACH,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:979-968-8820
Mailing Address - Street 1:2004 S US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-6127
Mailing Address - Country:US
Mailing Address - Phone:979-968-8820
Mailing Address - Fax:979-968-6598
Practice Address - Street 1:602 HICKORY ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-3055
Practice Address - Country:US
Practice Address - Phone:979-968-8820
Practice Address - Fax:979-968-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116409320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45G312Medicaid