Provider Demographics
NPI:1629290721
Name:LESLIE FOSTER HOME
Entity Type:Organization
Organization Name:LESLIE FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-544-0337
Mailing Address - Street 1:4063 BASEBALL POND ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602
Mailing Address - Country:US
Mailing Address - Phone:352-544-0337
Mailing Address - Fax:352-544-0391
Practice Address - Street 1:4063 BASEBALL POND ROAD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602
Practice Address - Country:US
Practice Address - Phone:352-544-0337
Practice Address - Fax:352-544-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility