Healthcare Provider Details

I. General information

NPI: 1437758885
Provider Name (Legal Business Name): LEGACY HOSPICE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13207 E STATE ROUTE 169 SUITE B-2
DEWEY AZ
86327
US

IV. Provider business mailing address

13207 E STATE ROUTE 169 SUITE B-2
DEWEY AZ
86327
US

V. Phone/Fax

Practice location:
  • Phone: 218-849-9549
  • Fax:
Mailing address:
  • Phone: 218-849-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EMILY MARIE KUMARALVAREZ HANSON
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential:
Phone: 218-849-9549