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General NPI Number Information
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NPI Number | 1083591911
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Entity Type | Organization
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Legal Business Name | LEGACY COMPREHENSIVE HEALTH MANAGEMENT LLC.
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 412 INGLESIDE AVE
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City | EMPORIA
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State | VA
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Zip | 23847-2320
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Country | US
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Telephone | 434-532-2164
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Fax |
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Provider Business Mailing Address
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Address Line | 302 S RUSSELL ST
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City | GASTON
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State | NC
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Zip | 27832-9784
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Country | US
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Telephone | 252-578-8334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL JOLETTE MASON-DICKENS
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Credential |
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Telephone | 252-578-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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