Provider Demographics
NPI:1699180687
Name:ELDRIDGE, LESLEE
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45146
Mailing Address - Country:US
Mailing Address - Phone:937-728-1912
Mailing Address - Fax:937-728-1912
Practice Address - Street 1:2458 TOWNSEND RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45146
Practice Address - Country:US
Practice Address - Phone:937-728-1912
Practice Address - Fax:937-728-1912
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker