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General NPI Number Information
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NPI Number | 1225563976
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH, INC.
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 7365 CARNELIAN ST 116A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1158
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Country | US
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Telephone | 909-608-7566
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Fax | 909-296-7321
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Provider Business Mailing Address
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Address Line | 7365 CARNELIAN ST 116A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1158
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Country | US
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Telephone | 909-608-7566
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Fax | 909-608-7567
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Authorized Official
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Title or Position | ADMINISTRATOR/DPCS
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Name | MACEDONIA MENDOZA
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Credential | RN
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Telephone | 562-858-1861
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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 | 550000450
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License Number State | CA
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