Healthcare Provider Details

I. General information

NPI: 1508556457
Provider Name (Legal Business Name): LIVING LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 29TH AVE N APT C
BIRMINGHAM AL
35207-5052
US

IV. Provider business mailing address

2116 29TH AVE N APT C
BIRMINGHAM AL
35207-5052
US

V. Phone/Fax

Practice location:
  • Phone: 205-899-1747
  • Fax:
Mailing address:
  • Phone: 205-899-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LADEANA BUCHANAN
Title or Position: LPN/NURSE
Credential: LPN
Phone: 205-899-1747