MEDICARE: LEGACY LIVING HOME HEALTHCARE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1619808748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY LIVING HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	2625 CHANNING DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3804
Country	:	US
Telephone Number	:	469-556-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 CHANNING DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3804
Country	:	US
Telephone Number	:	469-556-4768
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEXTER LEVERING
Credential	:
Telephone Number	:	469-556-4768

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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