Provider Demographics
NPI:1689890592
Name:JANICE M. LEONARD
Entity Type:Organization
Organization Name:JANICE M. LEONARD
Other - Org Name:CUSTOM CARE HCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:WANDREY
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-297-0929
Mailing Address - Street 1:1413 W LOOP 281 STE 102
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2849
Mailing Address - Country:US
Mailing Address - Phone:903-297-0929
Mailing Address - Fax:903-297-5345
Practice Address - Street 1:1413 W LOOP 281 STE 102
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2849
Practice Address - Country:US
Practice Address - Phone:903-297-0929
Practice Address - Fax:903-297-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007923OtherCONTRACT # - DADS
TX88HOtherCOMPONENT CODE - DADS