Healthcare Provider Details

I. General information

NPI: 1942803879
Provider Name (Legal Business Name): LEGACY V HOME CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25701 N LAKELAND BLVD STE 113D
EUCLID OH
44132-2451
US

IV. Provider business mailing address

25701 N LAKELAND BLVD STE 113D
EUCLID OH
44132-2451
US

V. Phone/Fax

Practice location:
  • Phone: 216-849-1379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LATASHA S BOLDEN
Title or Position: CEO
Credential: MHA
Phone: 216-633-5757