Healthcare Provider Details

I. General information

NPI: 1174458368
Provider Name (Legal Business Name): LEGACY PATHWAYS OF VIRGINIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S 12TH ST
RICHMOND VA
23219-4053
US

IV. Provider business mailing address

11 S 12TH ST
RICHMOND VA
23219-4053
US

V. Phone/Fax

Practice location:
  • Phone: 434-257-6298
  • Fax:
Mailing address:
  • Phone: 434-257-6298
  • 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: JESSICA HARRIS
Title or Position: CEO
Credential:
Phone: 434-257-6298