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General NPI Number Information
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NPI Number | 1194019992
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Entity Type | Organization
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Legal Business Name | LEGACY COMMUNITY HEALTH SERVICES, INC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 1415 CALIFORNIA ST
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City | HOUSTON
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State | TX
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Zip | 77006-2602
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Country | US
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Telephone | 832-548-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66308
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City | HOUSTON
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State | TX
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Zip | 77266-6308
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Country | US
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Telephone | 832-548-5076
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KATHERINE CALDWELL
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Credential |
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Telephone | 832-548-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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