Healthcare Provider Details

I. General information

NPI: 1033319223
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: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E FERGUSON ST SUITE C
PHARR TX
78577-1826
US

IV. Provider business mailing address

5277 OLD BROWNSVILLE RD SUTIE 205
CORPUS CHRISTI TX
78405-3929
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-9947
  • Fax: 956-787-1779
Mailing address:
  • Phone: 361-855-0848
  • Fax: 631-854-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number008442
License Number StateTX

VIII. Authorized Official

Name: AMBROSE HERNANDEZ
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 361-855-0848