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General NPI Number Information
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NPI Number | 1306699822
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Entity Type | Organization
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Legal Business Name | LEGACY UNITED HOMEHEALTH CARE, LLC
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 15516 EXMORE CT
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City | WOODBRIDGE
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State | VA
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Zip | 22191-1491
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Country | US
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Telephone | 571-993-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 15516 EXMORE CT
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City | WOODBRIDGE
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State | VA
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Zip | 22191-1491
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Country | US
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Telephone | 571-993-0645
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINSTRATOR
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Name | CHRISTOPHER KOROMA
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Credential |
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Telephone | 571-993-0645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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