Provider Demographics
NPI:1275183204
Name:LEONILLE HOME CARE LLC
Entity Type:Organization
Organization Name:LEONILLE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIRAGUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-338-0975
Mailing Address - Street 1:1450 W MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6969
Mailing Address - Country:US
Mailing Address - Phone:602-338-0975
Mailing Address - Fax:602-368-1493
Practice Address - Street 1:1450 W MULBERRY DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6969
Practice Address - Country:US
Practice Address - Phone:602-338-0975
Practice Address - Fax:602-368-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility