Provider Demographics
NPI:1609211309
Name:L & J HOMES, INC.
Entity type:Organization
Organization Name:L & J HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:LEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-8030
Mailing Address - Street 1:P.O. BOX 2273
Mailing Address - Street 2:1355 N. CHURCH STREET
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2803
Mailing Address - Country:US
Mailing Address - Phone:336-227-8030
Mailing Address - Fax:336-227-3288
Practice Address - Street 1:803 ELIZABETH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2545
Practice Address - Country:US
Practice Address - Phone:336-227-5593
Practice Address - Fax:336-227-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 251S00000X
NCMHL001073320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409397Medicaid