MEDICARE: LEGACY LIVING SOLUTIONS, CORP

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1396678496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY LIVING SOLUTIONS, CORP

Provider Business Mailing Address
First Line	:	1425 E GUN HILL RD APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3066
Country	:	US
Telephone Number	:	914-733-2168
Fax Number	:	718-320-4735

Provider Business Practice Location Address
First Line	:	1425 E GUN HILL RD APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3066
Country	:	US
Telephone Number	:	914-733-2168
Fax Number	:	718-320-4735

Authorized Official
Title or Position	:	ACCOUNTS PAYABLE
Name	:	SHEIK KHAN
Credential	:
Telephone Number	:	718-320-4734

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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