Provider Demographics
NPI:1407021124
Name:BOBBY LEATHERS JR
Entity Type:Organization
Organization Name:BOBBY LEATHERS JR
Other - Org Name:DOROTHY'S HOUSE OF CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEATHERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-475-4227
Mailing Address - Street 1:207 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3022
Mailing Address - Country:US
Mailing Address - Phone:919-475-4227
Mailing Address - Fax:919-598-5167
Practice Address - Street 1:207 NORMANDY ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3022
Practice Address - Country:US
Practice Address - Phone:919-475-4227
Practice Address - Fax:919-598-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities