NPIMap

Organization Active NPI

Leisure Home Life, Inc.

  • Adult Care Home Facility
  • Tarboro, NC
National Provider Identifier
1063619724
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
FCL-033-003 Issued in NC
Legal business name
LEISURE HOME LIFE, INC.
Practice address
800 E Saint John St
Tarboro, NC 27886-4544
Phone
(252) 641-4107
Fax
(252) 973-8599
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tempsie D. Richardson
Title
President
Phone
(252) 641-4107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X FCL-033-003 NC Primary

Addresses

Primary practice location

800 E Saint John St
Tarboro, NC 27886-4544

Mailing address

PO Box 2087
Rocky Mount, NC 27802-2087
Phone (252) 641-4107

Other identifiers 1

IdentifierTypeStateIssuer
780233MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Leisure Home Life Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063619724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2087",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278022087",
            "telephone_number": "252-641-4107",
            "fax_number": "252-973-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E SAINT JOHN ST",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278864544",
            "telephone_number": "252-641-4107",
            "fax_number": "252-973-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE HOME LIFE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "TEMPSIE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-641-4107",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-033-003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "780233",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.