Healthcare Provider Details

I. General information

NPI: 1104745447
Provider Name (Legal Business Name): LEGACY CARE VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MAIN ST
EAST HAVEN CT
06512-2920
US

IV. Provider business mailing address

130 FORD ST
MILFORD CT
06461-2550
US

V. Phone/Fax

Practice location:
  • Phone: 203-935-8545
  • Fax: 973-637-4478
Mailing address:
  • Phone: 203-935-8545
  • Fax: 973-637-4478

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: MR. JOSE BAUTISTA DACUYCUY III
Title or Position: MANAGING PARTNER AND OWNER
Credential: RN
Phone: 203-935-8545