Healthcare Provider Details

I. General information

NPI: 1073428728
Provider Name (Legal Business Name): OUR FATHERS LEGACY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 E PAULDING RD LOT 47
FORT WAYNE IN
46816-1203
US

IV. Provider business mailing address

1503 E PAULDING RD LOT 47
FORT WAYNE IN
46816-1203
US

V. Phone/Fax

Practice location:
  • Phone: 260-258-6305
  • Fax:
Mailing address:
  • Phone: 260-258-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: WANDA DENISE BRAWLEY
Title or Position: OWNER / CEO
Credential:
Phone: 260-258-6305