Provider Demographics
NPI:1932558053
Name:LEES PERSONAL ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LEES PERSONAL ASSISTED LIVING LLC
Other - Org Name:LEES PERSONAL ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADM.
Authorized Official - Prefix:MS
Authorized Official - First Name:JACOBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DARDY
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:706-773-5792
Mailing Address - Street 1:105 S 6TH AVE
Mailing Address - Street 2:105 SOUTH 6 AVENUE
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-2415
Mailing Address - Country:US
Mailing Address - Phone:706-773-5792
Mailing Address - Fax:334-644-4441
Practice Address - Street 1:105 S 6TH AVE
Practice Address - Street 2:105 SOUTH 6 AVENUE
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-2415
Practice Address - Country:US
Practice Address - Phone:706-773-5792
Practice Address - Fax:334-644-4441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL259316257261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center