Provider Demographics
NPI:1487929089
Name:THE LEACH HOME
Entity type:Organization
Organization Name:THE LEACH HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:701-642-4283
Mailing Address - Street 1:714 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3939
Mailing Address - Country:US
Mailing Address - Phone:701-642-4283
Mailing Address - Fax:701-642-1500
Practice Address - Street 1:714 4TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3939
Practice Address - Country:US
Practice Address - Phone:701-642-4283
Practice Address - Fax:701-642-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8033A311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility