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General NPI Number Information
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NPI Number | 1073479275
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Entity Type | Organization
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Legal Business Name | THE LEGACY FOUNDATIONS
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 5503 WEST 9000 SOUTH APT B 201
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City | WEST JORDAN
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State | UT
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Zip | 84081
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Country | US
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Telephone | 801-556-4037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 632
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City | WEST JORDAN
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State | UT
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Zip | 84084-0632
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Country | US
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Telephone | 801-556-4037
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIP BOUNYASANE
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Credential |
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Telephone | 801-556-4037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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