Healthcare Provider Details

I. General information

NPI: 1457277055
Provider Name (Legal Business Name): LEGACY HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 WYOMING ST
KANSAS CITY MO
64111-3770
US

IV. Provider business mailing address

3381 WYOMING ST
KANSAS CITY MO
64111-3770
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-6103
  • Fax:
Mailing address:
  • Phone: 913-777-6103
  • 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: MRS. REEYANA CLARK
Title or Position: OWNER
Credential: CNA
Phone: 913-777-6103