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General NPI Number Information
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NPI Number | 1023817988
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4846 NW LAKE JEFFERY RD
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City | LAKE CITY
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State | FL
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Zip | 32055-4797
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Country | US
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Telephone | 386-344-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 4846 NW LAKE JEFFERY RD
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City | LAKE CITY
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State | FL
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Zip | 32055-4797
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Country | US
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Telephone | 386-344-1422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERICA MAYO
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Credential | PHARMD
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Telephone | 386-344-1422
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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 |
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License Number State |
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