Healthcare Provider Details

I. General information

NPI: 1508781220
Provider Name (Legal Business Name): AM LEGACY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MYRTLEWOOD LN
WILLINGBORO NJ
08046-2940
US

IV. Provider business mailing address

12 MYRTLEWOOD LN
WILLINGBORO NJ
08046-2940
US

V. Phone/Fax

Practice location:
  • Phone: 609-471-5137
  • Fax:
Mailing address:
  • Phone: 609-471-5137
  • 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: MS. ABIMBOLA ABIOLA
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 609-471-5137