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NPI Code Detail

MEDICARE: LEGACY HEART HOMES LLC

MEDICARE: LEGACY HEART HOMES 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1801740725
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY HEART HOMES LLC
Provider Business Mailing Address
First Line : 3841 NOTTER AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6323
Country : US
Telephone Number : 904-862-1380
Fax Number :
Provider Business Practice Location Address
First Line : 7224 KEN KNIGHT DR E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-1212
Country : US
Telephone Number : 904-572-2226
Fax Number :
Authorized Official
Title or Position : OWNER
Name : WALDEN JEROME NATHAN
Credential :
Telephone Number : 904-572-2226
Provider Enumeration Date : 02/26/2026
Last Update Date : 02/26/2026

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Directions to “LEGACY HEART HOMES LLC ” Practice Location

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