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General NPI Number Information
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NPI Number | 1306730635
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Entity Type | Organization
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Legal Business Name | LEGACY CENTER FOR BIRTH AND WELLNESS
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 555 S BLACKBIRD ROOST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-6296
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Country | US
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Telephone | 928-779-6064
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Fax | 928-773-9694
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Provider Business Mailing Address
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Address Line | 555 S BLACKBIRD ROOST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-6296
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Country | US
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Telephone | 928-779-6064
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Fax | 928-773-9694
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRYSTAL HARRIS
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Credential | CPM
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Telephone | 928-779-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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