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General NPI Number Information
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NPI Number | 1033460712
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Entity Type | Organization
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Legal Business Name | LEGACY ASSISTANCE, LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 900 N SWALLOWTAIL DR UNIT G-107
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City | PORT ORANGE
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State | FL
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Zip | 32129-6102
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Country | US
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Telephone | 386-256-4904
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Fax | 386-256-4905
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Provider Business Mailing Address
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Address Line | 900 N SWALLOWTAIL DR UNIT G-107
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City | PORT ORANGE
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State | FL
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Zip | 32129-6102
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Country | US
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Telephone | 386-256-4904
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Fax | 386-256-4905
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Authorized Official
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Title or Position | VP OF QUALITY, SAFETY, RISK
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Name | PATRICIA S SANDERS
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Credential | RN, CPHRM
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Telephone | 770-360-5554
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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 | FL
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