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General NPI Number Information
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NPI Number | 1114173549
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Entity Type | Organization
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Legal Business Name | JT LEGACY, LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 100 OLD CHEROKEE RD SUITE F-122
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City | LEXINGTON
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State | SC
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Zip | 29072-9316
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Country | US
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Telephone | 803-873-0035
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Fax | 803-753-8321
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Provider Business Mailing Address
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Address Line | 100 OLD CHEROKEE RD SUITE F-122
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City | LEXINGTON
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State | SC
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Zip | 29072-9316
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Country | US
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Telephone | 803-873-0035
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Fax | 803-753-8321
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JOSEPH HOLMES
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Credential |
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Telephone | 803-873-0035
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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 | SC
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