MEDICARE: LEGACY OUTREACH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251S00000X	Community/Behavioral Health Agency
3	172V00000X	Community Health Worker
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1477270130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY OUTREACH SERVICES

Provider Business Mailing Address
First Line	:	800 WILCREST DR STE 107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 WILCREST DR STE 107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1369
Country	:	US
Telephone Number	:	757-769-5329
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANTHONY HINES
Credential	:
Telephone Number	:	804-337-9048

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	01/10/2025

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Directions to “LEGACY OUTREACH SERVICES ” Practice Location

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