Healthcare Provider Details

I. General information

NPI: 1992622781
Provider Name (Legal Business Name): LEGACY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RIDGEWAY CENTER PKWY
MEMPHIS TN
38120-4032
US

IV. Provider business mailing address

5865 RIDGEWAY CENTER PKWY
MEMPHIS TN
38120-4032
US

V. Phone/Fax

Practice location:
  • Phone: 602-895-0272
  • Fax:
Mailing address:
  • Phone: 602-895-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KAMISIA JONES
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 602-895-0272