Healthcare Provider Details

I. General information

NPI: 1790695997
Provider Name (Legal Business Name): LEGACY COMFORT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SYRAH WAY
ST AUGUSTINE FL
32084-2583
US

IV. Provider business mailing address

302 SYRAH WAY
ST AUGUSTINE FL
32084-2583
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-9424
  • Fax:
Mailing address:
  • Phone: 904-755-9424
  • 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: MS. LAKISHA RIVERS
Title or Position: OWNER
Credential:
Phone: 904-755-9424