Provider Demographics
NPI:1013387109
Name:LEISURE HOMECARE LLC
Entity Type:Organization
Organization Name:LEISURE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-946-2699
Mailing Address - Street 1:5862 POST CORNERS TRL APT A
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6330
Mailing Address - Country:US
Mailing Address - Phone:703-946-2699
Mailing Address - Fax:
Practice Address - Street 1:5862 POST CORNERS TRL APT A
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-6330
Practice Address - Country:US
Practice Address - Phone:703-946-2699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health