Healthcare Provider Details

I. General information

NPI: 1043175755
Provider Name (Legal Business Name): LEGACY CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 ALBRECHT DR
PROSPECT KY
40059-8105
US

IV. Provider business mailing address

PO BOX 22736
LOUISVILLE KY
40252-0736
US

V. Phone/Fax

Practice location:
  • Phone: 502-396-3545
  • Fax:
Mailing address:
  • Phone:
  • 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: MARCUS FORWARD SR.
Title or Position: PRESIDENT
Credential:
Phone: 502-396-3545