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General NPI Number Information
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NPI Number | 1033319223
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH AGENCY, INC.
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 213 E FERGUSON ST SUITE C
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City | PHARR
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State | TX
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Zip | 78577-1826
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Country | US
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Telephone | 956-787-9947
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Fax | 956-787-1779
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Provider Business Mailing Address
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Address Line | 5277 OLD BROWNSVILLE RD SUTIE 205
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City | CORPUS CHRISTI
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State | TX
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Zip | 78405-3929
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Country | US
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Telephone | 361-855-0848
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Fax | 631-854-6795
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | AMBROSE HERNANDEZ
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Credential |
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Telephone | 361-855-0848
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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 | 008442
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License Number State | TX
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