Provider Demographics
NPI:1871914614
Name:LESLY'LESISURE LIVING III
Entity type:Organization
Organization Name:LESLY'LESISURE LIVING III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:THELOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-661-1285
Mailing Address - Street 1:8080 NW 51 ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-661-1285
Mailing Address - Fax:954-616-8930
Practice Address - Street 1:8080 NW 51 ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-661-1285
Practice Address - Fax:954-616-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility