Healthcare Provider Details

I. General information

NPI: 1629886619
Provider Name (Legal Business Name): LEGACY INTEGRATED CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 INDIA HOOK RD STE C
ROCK HILL SC
29732-1992
US

IV. Provider business mailing address

1770 INDIA HOOK RD STE C
ROCK HILL SC
29732-1992
US

V. Phone/Fax

Practice location:
  • Phone: 803-324-6955
  • Fax:
Mailing address:
  • Phone: 803-324-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID CAMPANELLA
Title or Position: OWNER
Credential:
Phone: 803-324-6955