# MR. JAMAAL LEE LEATHERS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1720416043
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL-032-132 | NC | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | FCL-032-132 | NC | — |
| 376G00000X | Nursing Home Administrator | FCL-032-132 | NC | — |

## Other

- **Enumeration date:** 10/23/2013
- **Last updated:** 04/02/2014