Organization
LEISURE HOME LIFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TEMPSIE D. RICHARDSON (PRESIDENT)
(252) 641-4107
Entity
Organization
Contact information
Practice address
800 E SAINT JOHN ST, TARBORO, NC 27886-4544
(252) 641-4107
(252) 973-8599
Mailing address
PO BOX 2087, ROCKY MOUNT, NC 27802-2087
(252) 641-4107
(252) 973-8599
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-033-003
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
780233
—
NC
Enumeration date
06/27/2007
Last updated
08/22/2020
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