Provider Demographics
NPI:1164183851
Name:LECROIX HEALTH
Entity Type:Organization
Organization Name:LECROIX HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFFINEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-356-4038
Mailing Address - Street 1:2625 PIEDMONT RD NE STE 56-117
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3086
Mailing Address - Country:US
Mailing Address - Phone:678-356-4038
Mailing Address - Fax:
Practice Address - Street 1:8 CANTEY PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4007
Practice Address - Country:US
Practice Address - Phone:678-356-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care