Leisure Life Care Home Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LEISURE LIFE CARE HOME INC

Practice address

301 Beacham Street
Unadilla, GA 31091

Phone

(478) 892-2058

Fax

(478) 892-2058

NPI assigned

Feb 21, 2007

Last updated

Aug 22, 2020By 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

Dora Watson

Title

Pres

Phone

(478) 892-2058

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811032030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "31036",
            "telephone_number": "478-892-2058",
            "fax_number": "478-892-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BEACHAM STREET",
            "city": "UNADILLA",
            "state": "GA",
            "postal_code": "31091",
            "telephone_number": "478-892-2058",
            "fax_number": "478-892-2058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE LIFE CARE HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "DORA",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "478-892-2058"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Healthcare of Unadilla LLC
• Alicia Henderson
• Alexander Chukwuma Ibezi-Enendu, D.O.
• Kimberly Crump Johnson, NP-C
• Kristie Lashawn Lawson, FNP
• Malozera Primary Care, LLC
• Laquish Denise Martin
• Bianca Lester McBurse, FNP-BC
• McMahan Pharmacy, Inc
• Dhara Patel

• Assisted Living Facility in Unadilla, GA
• Providers in Unadilla, GA by specialty
• Assisted Living Facility in Georgia

• 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.