=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033238241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACY HOSPICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 10/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 WEST KEISER AVE
-----------------------------------------------------
City | OSCEOLA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-563-9995
-----------------------------------------------------
Fax | 870-563-8455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2130
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-652-6167
-----------------------------------------------------
Fax | 205-742-0028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. LEWIS CLARK BLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-652-6167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | AR4223
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------