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General NPI Number Information
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NPI Number | 1003797101
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Entity Type | Organization
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Legal Business Name | Y&R LEGACIES LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 37861 LOPEZ LN
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City | PALMDALE
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State | CA
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Zip | 93552-4140
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Country | US
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Telephone | 213-222-6745
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 FREMONT AVE UNIT 3533
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3224
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Country | US
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Telephone | 213-222-6745
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | MR. YANCY WAYDELL FORT JR.
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Credential |
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Telephone | 213-222-6745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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