Healthcare Provider Details

I. General information

NPI: 1124228317
Provider Name (Legal Business Name): LEGACY HOME HEALTH AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 OLD BROWNSVILLE RD STE 205
CORPUS CHRISTI TX
78405-3930
US

IV. Provider business mailing address

6655 FIRST PARK TEN BLVD STE 200
SAN ANTONIO TX
78213-4304
US

V. Phone/Fax

Practice location:
  • Phone: 361-855-0848
  • Fax: 361-853-4855
Mailing address:
  • Phone: 210-736-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number008442
License Number StateTX

VIII. Authorized Official

Name: MR. AMBROSE HERNANDEZ JR.
Title or Position: CEO/OWNER
Credential:
Phone: 361-855-0848