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General NPI Number Information
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NPI Number | 1306105945
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE MANAGEMENT, INC.
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 4800 W 13TH ST STE #D
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City | LITTLE ROCK
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State | AR
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Zip | 72204-1900
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Country | US
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Telephone | 501-353-2035
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 W 13TH ST STE #D
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City | LITTLE ROCK
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State | AR
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Zip | 72204-1900
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Country | US
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Telephone | 501-353-2035
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JULIUS LAMONT MOORE
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Credential | LNHA
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Telephone | 501-392-2924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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