Provider Demographics
NPI:1740356559
Name:LEILANI RAGUCKAS
Entity type:Organization
Organization Name:LEILANI RAGUCKAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEILANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUCKAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-344-6604
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:DE PEYSTER
Mailing Address - State:NY
Mailing Address - Zip Code:13633-0023
Mailing Address - Country:US
Mailing Address - Phone:315-344-6604
Mailing Address - Fax:
Practice Address - Street 1:4396 COUNTY ROUTE 10
Practice Address - Street 2:
Practice Address - City:DE PEYSTER
Practice Address - State:NY
Practice Address - Zip Code:13633-0023
Practice Address - Country:US
Practice Address - Phone:315-344-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557596163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty