Healthcare Provider Details

I. General information

NPI: 1477067502
Provider Name (Legal Business Name): LEGACY HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/27/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S LAWRENCE BLVD
KEYSTONE HEIGHTS FL
32656-9222
US

IV. Provider business mailing address

7384 STATE ROAD 21 KEYSTONE HEIGHTS, FL 32656
KEYSTONE HEIGHTS FL
32656
US

V. Phone/Fax

Practice location:
  • Phone: 352-478-7030
  • Fax: 352-478-7035
Mailing address:
  • Phone: 523-478-7030
  • Fax: 352-478-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994720
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number299994720
License Number StateFL

VIII. Authorized Official

Name: MRS. ELIZABETH MURPHY
Title or Position: OWNER
Credential: RN
Phone: 352-478-7030