Provider Demographics
NPI:1669479275
Name:JOHN T. LESLIE, II, INC.
Entity Type:Organization
Organization Name:JOHN T. LESLIE, II, INC.
Other - Org Name:TLC HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-591-0915
Mailing Address - Street 1:15110 MINTZ LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1412
Mailing Address - Country:US
Mailing Address - Phone:281-591-0915
Mailing Address - Fax:
Practice Address - Street 1:15110 MINTZ LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1412
Practice Address - Country:US
Practice Address - Phone:281-591-0915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008636251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453114Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER