Healthcare Provider Details

I. General information

NPI: 1629301130
Provider Name (Legal Business Name): LEGACY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 GREENSBORO RD
HIGH POINT NC
27260-2611
US

IV. Provider business mailing address

3001 SPRING FOREST RD
RALEIGH NC
27616-2815
US

V. Phone/Fax

Practice location:
  • Phone: 133-682-1692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MANAL ALAN FAKHOURY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A., CFY-SLP
Phone: 919-306-1847