Leisure Living Management of Portage, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

23D0975380 Issued in MI

Legal business name

LEISURE LIVING MANAGEMENT OF PORTAGE, INC.

Doing business as

Fountain View of Portage - Laboratory

Practice address

7818 Kenmure Dr
Portage, MI 49024-5082

Phone

(269) 327-9595

NPI assigned

Jul 9, 2010

Last updated

Jul 9, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Nobel

Title

President

Phone

(269) 327-9595

Specialties & licenses 1

Addresses

Other names 1

• Fountain View of Portage - Laboratory Doing business as

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1063724870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7818 KENMURE DR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245082",
            "telephone_number": "269-327-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7818 KENMURE DR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245082",
            "telephone_number": "269-327-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE LIVING MANAGEMENT OF PORTAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "NOBEL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-327-9595",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D0975380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain View of Portage - Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caleb Learman
• Natishia Raylynne Ledesma, MSW
• Kyoung Kelly Lee, NP
• Rachel D Lefler, M.A. BCBA
• Samuel Edward Lehouiller, RPH
• Tori Ann Leiter, LLPC
• Valerie Justine Leith
• Paul Leitz
• Harry John Lekosiotis, P.T.
• Carah Beth Lemmen

• Clinical Medical Laboratory in Portage, MI
• Providers in Portage, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; 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.