MEDICARE: LEGACY HOSPICE, L.L.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1174683312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HOSPICE, L.L.C

Provider Business Mailing Address
First Line	:	PO BOX 670
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-0670
Country	:	US
Telephone Number	:	505-454-8099
Fax Number	:	505-454-8094

Provider Business Practice Location Address
First Line	:	2808 HOT SPRINGS BOULEVARD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-0670
Country	:	US
Telephone Number	:	505-454-8099
Fax Number	:	505-454-8094

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	RAMONA ELEANOR ULIBARRI
Credential	:	RN
Telephone Number	:	505-454-8099

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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