Organization
LESLY'LEISURE LIVING II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC R THELOT (ASSISTANT ADMINISTRATOR)
(954) 661-1285
Entity
Organization
Contact information
Practice address
6461 NW 90TH AVE, TAMARAC, FL 33321-3621
(954) 724-5470
(954) 721-9171
Mailing address
6461 NW 90TH AVE, TAMARAC, FL 33321-3621
(954) 724-5470
(954) 721-9171
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11220
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002679100
—
FL
Enumeration date
12/17/2013
Last updated
12/17/2013
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