Healthcare Provider Details

I. General information

NPI: 1497678320
Provider Name (Legal Business Name): LEGACY SENIOR ENRICHMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 RHYNE RD
CHARLOTTE NC
28214-0700
US

IV. Provider business mailing address

1205 RHYNE RD
CHARLOTTE NC
28214-0700
US

V. Phone/Fax

Practice location:
  • Phone: 608-234-2719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NELSON
Title or Position: FOUNDER
Credential:
Phone: 608-234-2719