Healthcare Provider Details

I. General information

NPI: 1528727229
Provider Name (Legal Business Name): A LEGACY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 VICKSBURG DR
ARLINGTON TX
76017-4946
US

IV. Provider business mailing address

5410 VICKSBURG DR
ARLINGTON TX
76017-4946
US

V. Phone/Fax

Practice location:
  • Phone: 817-516-5349
  • Fax: 817-765-2136
Mailing address:
  • Phone: 817-516-5349
  • Fax: 817-765-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANDLER TENILLE ANGEL
Title or Position: OWNER
Credential:
Phone: 131-637-1691