Provider Demographics
NPI:1659496511
Name:LEESBURG HEALTH & REHAB LLC
Entity Type:Organization
Organization Name:LEESBURG HEALTH & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CASTLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-728-3020
Mailing Address - Street 1:715 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5926
Mailing Address - Country:US
Mailing Address - Phone:352-728-3020
Mailing Address - Fax:
Practice Address - Street 1:715 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5926
Practice Address - Country:US
Practice Address - Phone:352-728-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12910961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105375Medicare Oscar/Certification