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General NPI Number Information
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NPI Number | 1154881126
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HOSPICE LLC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 275 CORPORATE CENTER DR STE C
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7377
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Country | US
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Telephone | 678-735-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 5284 FLOYD RD SW UNIT 1538
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City | MABLETON
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State | GA
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Zip | 30126-6114
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Country | US
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Telephone | 678-735-6001
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CASSANDRA FREEMAN
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Credential |
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Telephone | 678-335-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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