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General NPI Number Information
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NPI Number | 1417710153
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTH AND WELLNESS
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 10112 KINSMAN RD
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City | CLEVELAND
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State | OH
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Zip | 44104-5367
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Country | US
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Telephone | 330-245-6518
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Fax |
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Provider Business Mailing Address
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Address Line | 10112 KINSMAN RD
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City | CLEVELAND
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State | OH
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Zip | 44104-5367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHILAH KIDD
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Credential |
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Telephone | 330-245-6518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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