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General NPI Number Information
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NPI Number | 1326630104
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE, LLC
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1070 A ST STE 5
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City | HAYWARD
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State | CA
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Zip | 94541-4106
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Country | US
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Telephone | 510-952-9906
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Fax | 510-952-9927
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Provider Business Mailing Address
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Address Line | 1070 A ST STE 5
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City | HAYWARD
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State | CA
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Zip | 94541-4106
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Country | US
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Telephone | 510-952-9906
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Fax | 510-952-9927
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN D WILLIAMS
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Credential |
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Telephone | 408-309-5661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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