Provider Demographics
NPI:1588029409
Name:LEROY PROPERTIES OF FLORIDA INC
Entity type:Organization
Organization Name:LEROY PROPERTIES OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-687-7142
Mailing Address - Street 1:2090 NW 115 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167
Mailing Address - Country:US
Mailing Address - Phone:305-687-7142
Mailing Address - Fax:305-687-7142
Practice Address - Street 1:2090 NW 115 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168
Practice Address - Country:US
Practice Address - Phone:305-687-7142
Practice Address - Fax:305-687-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140102500Medicaid