Healthcare Provider Details

I. General information

NPI: 1699601419
Provider Name (Legal Business Name): IJR LEGACY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15409 NW 121ST PL
ALACHUA FL
32615-0010
US

IV. Provider business mailing address

15409 NW 121ST PL
ALACHUA FL
32615-0010
US

V. Phone/Fax

Practice location:
  • Phone: 407-491-3841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRITTNEY INGRAM
Title or Position: MANAGING MEMBER
Credential:
Phone: 407-491-3841