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Organization
LEISURE LIFE CARE HOME INC
Active
Organization
LEISURE LIFE CARE HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORA WATSON (PRES)
(478) 892-2058
Entity
Organization
Contact information
Practice address
301 BEACHAM STREET, UNADILLA, GA 31091
(478) 892-2058
(478) 892-2058
Mailing address
PO BOX 568, HAWKINSVILLE, GA 31036
(478) 892-2058
(478) 892-2058
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00535477A
—
GA
Enumeration date
02/21/2007
Last updated
08/22/2020
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