MEDICARE: LEGACY NATIVE HOME CARE LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1184385882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY NATIVE HOME CARE LLC

Provider Business Mailing Address
First Line	:	5235 S AXIOM
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-8529
Country	:	US
Telephone Number	:	480-245-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	5235 S AXIOM
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-8529
Country	:	US
Telephone Number	:	480-865-5244
Fax Number	:

Authorized Official
Title or Position	:	CEO/ MANAGER
Name	:	TYRESE TOMEGAH
Credential	:
Telephone Number	:	480-865-5244

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	08/21/2025

Similar Medicare Providers

1932771417 — PARADISE SPRINGS HOMES
Practice Location Address:

5235 S AXIOM
MESA, AZ
85212-8529

Practice Phone: 213-373-3549
Practice Fax:

1336011527 — LEGACY NATIVE HOME CARE LLC
Practice Location Address:

5235 S AXIOM
MESA, AZ
85212-8529

Practice Phone: 480-245-4471
Practice Fax:

1659214997 — MADISON LAWRIE
Practice Location Address:

10065 E PANTERA AVE
MESA, AZ
85212-2302

Practice Phone: 208-446-7714
Practice Fax:

1851235147 — RENEWED SPIRIT RESIDENCES LLC
Practice Location Address:

8149 E POSADA AVE
MESA, AZ
85212-1667

Practice Phone: 623-312-5465
Practice Fax:

1508708108 — KRISTIN RENEE ROBINSON
Practice Location Address:

10539 E PALLADIUM DR
MESA, AZ
85212-9440

Practice Phone: 480-878-0460
Practice Fax:

1376485748 — SOSTEGNO CARE SOLUTIONS LLC
Practice Location Address:

8516 E OLLA AVE
MESA, AZ
85212-2182

Practice Phone: 480-570-5102
Practice Fax:

Directions to “LEGACY NATIVE HOME CARE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.