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General NPI Number Information
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NPI Number | 1033446299
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH, INC.
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 1111 W ROBINHOOD DR SUITE D
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City | STOCKTON
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State | CA
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Zip | 95207-5626
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Country | US
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Telephone | 209-474-0111
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Fax | 888-448-8212
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Provider Business Mailing Address
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Address Line | 1111 W ROBINHOOD DR SUITE D
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City | STOCKTON
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State | CA
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Zip | 95207-5626
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Country | US
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Telephone | 209-474-0111
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Fax | 888-448-8212
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GWENDOLYN BOSS
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Credential |
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Telephone | 209-483-3466
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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 | 550001148
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License Number State | CA
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