Healthcare Provider Details

I. General information

NPI: 1942174735
Provider Name (Legal Business Name): KJC LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 MANCHESTER RD STE F
COVENTRY TOWNSHIP OH
44319-1466
US

IV. Provider business mailing address

3515 MANCHESTER RD STE F
COVENTRY TOWNSHIP OH
44319-1466
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 Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY MERRIE MEISER
Title or Position: OWNER, CEO
Credential: LPN, LNHA-HSE
Phone: 330-599-7316