Healthcare Provider Details

I. General information

NPI: 1740971944
Provider Name (Legal Business Name): KJC LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 PORTAGE LAKES DR STE 7
COVENTRY TOWNSHIP OH
44319-2269
US

IV. Provider business mailing address

503 PORTAGE LAKES DR STE 7
COVENTRY TOWNSHIP OH
44319-2269
US

V. Phone/Fax

Practice location:
  • Phone: 330-599-7316
  • Fax: 330-599-7318
Mailing address:
  • Phone: 330-599-7316
  • Fax: 330-599-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLY MERRIE MEISER
Title or Position: OWNER, ADMINISTRATOR
Credential:
Phone: 330-599-7316