Provider Demographics
NPI:1871751453
Name:LEO CAPRI INC
Entity type:Organization
Organization Name:LEO CAPRI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM/D.O.N
Authorized Official - Prefix:MRS
Authorized Official - First Name:PUSHPAM
Authorized Official - Middle Name:SWAMY
Authorized Official - Last Name:MYDUR
Authorized Official - Suffix:
Authorized Official - Credentials:RNC,ANP
Authorized Official - Phone:817-689-1289
Mailing Address - Street 1:835 SW ALSBURY BLVD
Mailing Address - Street 2:SUITE ,J,
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4093
Mailing Address - Country:US
Mailing Address - Phone:817-920-0800
Mailing Address - Fax:817-920-0801
Practice Address - Street 1:835 SW ALSBURY BLVD
Practice Address - Street 2:SUITE ,J,
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4093
Practice Address - Country:US
Practice Address - Phone:817-920-0800
Practice Address - Fax:817-920-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011966251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health