Healthcare Provider Details

I. General information

NPI: 1407515687
Provider Name (Legal Business Name): LEGACY U HEALTH CARE CONSULTING & TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 MERTON DR STE 250
RALEIGH NC
27609-6636
US

IV. Provider business mailing address

3900 MERTON DR STE 250
RALEIGH NC
27609-6636
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-5093
  • Fax: 919-964-3105
Mailing address:
  • Phone: 252-258-5093
  • Fax: 919-964-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHONICA HARRIS JONES
Title or Position: DIRECTOR
Credential: RN
Phone: 191-951-6922