Provider Demographics
NPI:1235531633
Name:LESALDO HOUSE, LLC
Entity Type:Organization
Organization Name:LESALDO HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAWNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-873-1190
Mailing Address - Street 1:422 SW TULIP BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6243
Mailing Address - Country:US
Mailing Address - Phone:772-873-1190
Mailing Address - Fax:
Practice Address - Street 1:422 SW TULIP BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6243
Practice Address - Country:US
Practice Address - Phone:772-873-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health