=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376997932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACY HOME CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2016
-----------------------------------------------------
Last Update Date | 01/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2489 NW 7TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-591-1818
-----------------------------------------------------
Fax | 305-402-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2489 NW 7TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-591-1818
-----------------------------------------------------
Fax | 305-402-8111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MEGHAN GOICOURIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-591-1818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------