Healthcare Provider Details

I. General information

NPI: 1821908179
Provider Name (Legal Business Name): TM LEGACY SOLUTION
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

160 BROADWAY ST APT H6
CLINTON MS
39056-4833
US

IV. Provider business mailing address

160 BROADWAY ST APT H6
CLINTON MS
39056-4833
US

V. Phone/Fax

Practice location:
  • Phone: 601-506-0194
  • Fax:
Mailing address:
  • Phone: 601-506-0194
  • 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: TYKESHIA L JOHNSON
Title or Position: OWNER/AUTHORIZED
Credential:
Phone: 601-506-0194