Healthcare Provider Details

I. General information

NPI: 1033405956
Provider Name (Legal Business Name): LEGACY VALLEY HOSPICE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 PLANTATION GROVE BLVD SUITE 200
MISSION TX
78572-7604
US

IV. Provider business mailing address

PO BOX 60650
CORPUS CHRISTI TX
78466-0650
US

V. Phone/Fax

Practice location:
  • Phone: 361-855-0848
  • Fax:
Mailing address:
  • Phone: 361-855-0848
  • Fax: 361-854-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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