Provider Demographics
NPI:1851794838
Name:JIMMIE LEEDS SENIOR CARE, LLC
Entity Type:Organization
Organization Name:JIMMIE LEEDS SENIOR CARE, LLC
Other - Org Name:SPRING VILLAGE AT GALLOWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF PARENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-999-2400
Mailing Address - Street 1:1000 LEGION PL
Mailing Address - Street 2:SUITE 1750, C/O ROC SENIORS, ATTN: AMIT GHOSH
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1058
Mailing Address - Country:US
Mailing Address - Phone:407-999-2400
Mailing Address - Fax:407-999-7759
Practice Address - Street 1:46 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9401
Practice Address - Country:US
Practice Address - Phone:609-404-1099
Practice Address - Fax:609-404-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility