Healthcare Provider Details

I. General information

NPI: 1396678496
Provider Name (Legal Business Name): LEGACY LIVING SOLUTIONS, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E GUN HILL RD APT 2
BRONX NY
10469-3066
US

IV. Provider business mailing address

1425 E GUN HILL RD APT 2
BRONX NY
10469-3066
US

V. Phone/Fax

Practice location:
  • Phone: 914-733-2168
  • Fax: 718-320-4735
Mailing address:
  • Phone: 914-733-2168
  • Fax: 718-320-4735

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: SHEIK KHAN
Title or Position: ACCOUNTS PAYABLE
Credential:
Phone: 718-320-4734