Organization
JANICE M. LEONARD
Active
Other names
Custom Care HCS
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE WANDREY LEONARD (CEO / PROGRAM MANAGER)
(903) 297-0929
Entity
Organization
Contact information
Practice address
1413 W LOOP 281 STE 102, LONGVIEW, TX 75604-2849
(903) 297-0929
(903) 297-5345
Mailing address
1413 W LOOP 281 STE 102, LONGVIEW, TX 75604-2849
(903) 297-0929
(903) 297-5345
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001007923
CONTRACT # - DADS
TX
01
—
88H
COMPONENT CODE - DADS
TX
Enumeration date
04/18/2007
Last updated
01/22/2024
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