Healthcare Provider Details

I. General information

NPI: 1497695191
Provider Name (Legal Business Name): LEGACY LIVING CARE L, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 FLINT AVE
SAN JOSE CA
95148-1721
US

IV. Provider business mailing address

3277 S WHITE RD # 52
SAN JOSE CA
95148-4056
US

V. Phone/Fax

Practice location:
  • Phone: 408-944-5031
  • Fax:
Mailing address:
  • Phone: 408-944-5031
  • 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: LYNN NGUYEN
Title or Position: CEO / PARTNER
Credential:
Phone: 669-213-5519