Healthcare Provider Details

I. General information

NPI: 1215892237
Provider Name (Legal Business Name): LEGACY CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 FULTON DR NW STE 1
CANTON OH
44718-2300
US

IV. Provider business mailing address

4845 FULTON DR NW STE 2
CANTON OH
44718-2300
US

V. Phone/Fax

Practice location:
  • Phone: 330-510-2400
  • Fax: 330-510-2400
Mailing address:
  • Phone: 330-510-2400
  • Fax: 330-510-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOIRDAN CARTER
Title or Position: PARTNER
Credential:
Phone: 330-510-2400