Healthcare Provider Details

I. General information

NPI: 1336855147
Provider Name (Legal Business Name): LEGACY OUTREACH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 GARY AVE
CHESTER VA
23831-7406
US

IV. Provider business mailing address

14512 GLENMORGAN DR
CHESTER VA
23831-6638
US

V. Phone/Fax

Practice location:
  • Phone: 804-868-8311
  • Fax:
Mailing address:
  • Phone: 804-868-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LACHAN TORAN
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 804-868-8311