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NPI Code Detail

MEDICARE: LEGACY HEALTH & WELLNESS

MEDICARE: LEGACY HEALTH & WELLNESS
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1497095228
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY HEALTH & WELLNESS
Provider Business Mailing Address
First Line : 911 N BUFFALO DR
Second Line : 213
City : LAS VEGAS
State : NV
Zip : 89128-0379
Country : US
Telephone Number : 702-942-1774
Fax Number : 702-942-1773
Provider Business Practice Location Address
First Line : 911 N BUFFALO DR
Second Line : 213
City : LAS VEGAS
State : NV
Zip : 89128-0379
Country : US
Telephone Number : 702-942-1774
Fax Number : 702-942-1773
Authorized Official
Title or Position : DIRECTOR
Name : RANDE PAIGE
Credential :
Telephone Number : 702-942-1774
Provider Enumeration Date : 02/14/2013
Last Update Date : 02/14/2013

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Directions to “LEGACY HEALTH & WELLNESS ” Practice Location

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