Provider Demographics
NPI:1497171268
Name:LEORAY ALF INC. CO
Entity Type:Organization
Organization Name:LEORAY ALF INC. CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-559-9307
Mailing Address - Street 1:101 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5259
Mailing Address - Country:US
Mailing Address - Phone:954-559-9307
Mailing Address - Fax:954-404-7318
Practice Address - Street 1:101 THOMAS RD
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5259
Practice Address - Country:US
Practice Address - Phone:954-559-9307
Practice Address - Fax:954-404-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10836310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009693400Medicaid