Healthcare Provider Details

I. General information

NPI: 1982536892
Provider Name (Legal Business Name): LEGENDARY HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 E RAVENWOOD AVE
YOUNGSTOWN OH
44507-1921
US

IV. Provider business mailing address

242 E RAVENWOOD AVE
YOUNGSTOWN OH
44507-1921
US

V. Phone/Fax

Practice location:
  • Phone: 330-937-8227
  • Fax:
Mailing address:
  • Phone: 330-937-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER TAYLOR
Title or Position: OWNER
Credential: CARETAKER
Phone: 330-937-8227