Healthcare Provider Details

I. General information

NPI: 1043129513
Provider Name (Legal Business Name): LEGACY CARE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MANSELL CT E STE 405
ROSWELL GA
30076-4851
US

IV. Provider business mailing address

300 COLONIAL CENTER PKWY STE 100
ROSWELL GA
30076-4892
US

V. Phone/Fax

Practice location:
  • Phone: 470-822-6232
  • Fax: 470-765-1515
Mailing address:
  • Phone:
  • 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: PATRICK WIGGINS
Title or Position: OWNER
Credential:
Phone: 470-822-6232