MEDICARE: LEGACY V HOME CARE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942803879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY V HOME CARE

Provider Business Mailing Address
First Line	:	17325 EUCLID AVE STE 3030
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1255
Country	:	US
Telephone Number	:	216-849-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 3030
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1255
Country	:	US
Telephone Number	:	216-849-1379
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LATASHA S BOLDEN
Credential	:	MHA
Telephone Number	:	216-849-1379

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	11/22/2020

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Directions to “LEGACY V HOME CARE ” Practice Location

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