Healthcare Provider Details

I. General information

NPI: 1598600728
Provider Name (Legal Business Name): PEARL LEGACY HOME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 W CARTER RD
PHOENIX AZ
85041-6054
US

IV. Provider business mailing address

3917 W CARTER RD
PHOENIX AZ
85041-6054
US

V. Phone/Fax

Practice location:
  • Phone: 414-349-4432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MELONIE DAVIS
Title or Position: OWNER
Credential:
Phone: 414-349-4432