Healthcare Provider Details

I. General information

NPI: 1679400832
Provider Name (Legal Business Name): LEGACY IMPACT NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W 2ND ST STE 200
DAYTON OH
45402-1873
US

IV. Provider business mailing address

40 W 2ND ST STE 200
DAYTON OH
45402-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-867-9811
  • Fax:
Mailing address:
  • Phone: 937-867-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: QUINTON L ALSTORK
Title or Position: CEO
Credential: OWNER
Phone: 937-867-9811