Provider Demographics
NPI:1255348835
Name:LEANING TREE HOME CARE AGENCY
Entity type:Organization
Organization Name:LEANING TREE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATORRIE
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-257-8685
Mailing Address - Street 1:2520 MURCHISON RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3566
Mailing Address - Country:US
Mailing Address - Phone:910-822-2238
Mailing Address - Fax:
Practice Address - Street 1:2520 MURCHISON RD STE 3A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3566
Practice Address - Country:US
Practice Address - Phone:910-822-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3343251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418124Medicaid
NC6601469Medicaid