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General NPI Number Information
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NPI Number | 1003970104
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE PROVIDERS, INC.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 1272 CENTER COURT DR STE. 203
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City | COVINA
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State | CA
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Zip | 91724-3667
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Country | US
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Telephone | 626-858-5611
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Fax | 626-858-5614
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Provider Business Mailing Address
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Address Line | 1272 CENTER COURT DR STE. 203
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City | COVINA
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State | CA
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Zip | 91724-3667
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Country | US
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Telephone | 626-858-5611
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Fax | 626-858-5614
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Authorized Official
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Title or Position | ADMINISTRATOR, OWNER
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Name | MS. MARIEGENE CACHO
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Credential | RN, BSN
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Telephone | 626-858-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 980001464
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License Number State | CA
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