# LEISURE CARE HOME CARE AGENCY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174861108
- **Authorized official:** MR. TREVOR L BLACKANN (PRESIDENT)
- **Authorized official phone:** (949) 363-7401

## Contact information

- **Practice address:** 30131 TOWN CENTER DR, SUITE 205, LAGUNA NIGUEL, CA 92677-2034
- **Practice address phone:** (949) 363-7401
- **Practice address fax:** (949) 363-7419
- **Mailing address:** 30131 TOWN CENTER DR, SUITE 205, LAGUNA NIGUEL, CA 92677-2034
- **Mailing address phone:** (949) 363-7401
- **Mailing address fax:** (949) 363-7419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | C-2616981 | CA | Yes |

## Other

- **Enumeration date:** 01/25/2013
- **Last updated:** 01/25/2013