Provider Demographics
NPI:1750370656
Name:LEESBURG HEALTH AND REHAB
Entity type:Organization
Organization Name:LEESBURG HEALTH AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.N
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN/DM/CRAC/LNC
Authorized Official - Phone:352-728-3020
Mailing Address - Street 1:715 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5926
Mailing Address - Country:US
Mailing Address - Phone:352-728-3020
Mailing Address - Fax:352-787-6591
Practice Address - Street 1:715 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5926
Practice Address - Country:US
Practice Address - Phone:352-728-3020
Practice Address - Fax:352-787-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7250000105314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility