Healthcare Provider Details

I. General information

NPI: 1003736091
Provider Name (Legal Business Name): LEGACY HEARTS CARE SERVICES LLC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10962 W RADCLIFF DR
MARANA AZ
85653-0539
US

IV. Provider business mailing address

10962 W RADCLIFF DR
MARANA AZ
85653-0539
US

V. Phone/Fax

Practice location:
  • Phone: 520-409-7241
  • Fax:
Mailing address:
  • Phone: 520-409-7241
  • Fax:

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: MRS. JAMELLA GORY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 520-409-7241