Provider Demographics
NPI:1043406002
Name:LEAK'S FAMILY CARE HOME
Entity Type:Organization
Organization Name:LEAK'S FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRINFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-774-6662
Mailing Address - Street 1:811 HILLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5530
Mailing Address - Country:US
Mailing Address - Phone:919-774-6662
Mailing Address - Fax:
Practice Address - Street 1:548 COX MADDOX RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-8019
Practice Address - Country:US
Practice Address - Phone:919-258-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility