Provider Demographics
NPI:1952657959
Name:INTERIM HEALTHCARE OF LEESBURG, LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF LEESBURG, LLC
Other - Org Name:INTERIM HEALTHCARE OF WEST CENTRAL FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-645-3211
Mailing Address - Street 1:1890 STATE ROAD 436
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2228
Mailing Address - Country:US
Mailing Address - Phone:407-645-3211
Mailing Address - Fax:407-628-2853
Practice Address - Street 1:463 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5680
Practice Address - Country:US
Practice Address - Phone:352-637-3111
Practice Address - Fax:352-637-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20575095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health