Provider Demographics
NPI:1700473006
Name:LESLIE'S PERSONAL CARE SERVICES, LLC
Entity Type:Organization
Organization Name:LESLIE'S PERSONAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-790-5762
Mailing Address - Street 1:PO BOX 1751
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-1751
Mailing Address - Country:US
Mailing Address - Phone:814-790-5762
Mailing Address - Fax:814-240-8137
Practice Address - Street 1:1612 CHERRY ST APT 3
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1740
Practice Address - Country:US
Practice Address - Phone:814-790-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251E00000XAgenciesHome Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE088660Medicaid