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General NPI Number Information
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NPI Number | 1235087388
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Entity Type | Organization
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Legal Business Name | LEGACY LIFE FAMILY SUPPORT PROFESSIONALS INC.
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 1800 N MCCORD RD APT 94
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City | TOLEDO
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State | OH
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Zip | 43615-3073
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Country | US
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Telephone | 567-416-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 N MCCORD RD APT 94
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City | TOLEDO
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State | OH
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Zip | 43615-3073
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Country | US
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Telephone | 567-416-8001
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN MARQUISE WILLIAMS-EL
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Credential | DSP
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Telephone | 567-416-8001
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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 |
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