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General NPI Number Information
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NPI Number | 1417260357
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 8385 CARDOVA CIR
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City | RICHMOND
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State | VA
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Zip | 23227-1548
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Country | US
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Telephone | 804-908-7374
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Fax | 804-354-6006
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Provider Business Mailing Address
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Address Line | 6033 BONNEAU RD
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City | RICHMOND
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State | VA
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Zip | 23227-2008
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Country | US
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Telephone | 804-908-7374
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Fax | 804-354-6006
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. TANYA JUDON-WINSTON
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Credential |
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Telephone | 804-908-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1212-01-001
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License Number State | VA
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