Healthcare Provider Details

I. General information

NPI: 1861303463
Provider Name (Legal Business Name): SHANNA LEGACY HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 MAYS RD
JONESBORO AR
72405
US

IV. Provider business mailing address

1308 MAYS RD
JONESBORO AR
72405
US

V. Phone/Fax

Practice location:
  • Phone: 870-666-2648
  • Fax: 870-666-2648
Mailing address:
  • Phone: 870-666-2648
  • Fax: 870-666-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNA MARIE BAREFIELD
Title or Position: CEO
Credential:
Phone: 870-666-2648