Provider Demographics
NPI:1447060835
Name:LEISURE TIMES HOME
Entity type:Organization
Organization Name:LEISURE TIMES HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTEANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-215-2816
Mailing Address - Street 1:11678 W YUCCA CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-2518
Mailing Address - Country:US
Mailing Address - Phone:623-215-2816
Mailing Address - Fax:
Practice Address - Street 1:11678 W YUCCA CT
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-2518
Practice Address - Country:US
Practice Address - Phone:623-215-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility