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General NPI Number Information
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NPI Number | 1194695411
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Entity Type | Organization
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Legal Business Name | LEGACY BLOOMS SENIOR SOLUTIONS LLC
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 6900 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2775
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Country | US
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Telephone | 870-253-3219
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2775
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Country | US
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Telephone | 870-253-3219
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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 | DESIREE D GRAVES
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Credential |
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Telephone | 870-253-3219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 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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