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General NPI Number Information
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NPI Number | 1417727314
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Entity Type | Organization
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Legal Business Name | LEGACY RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 20 GARFIELD ST APT 11
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City | SACO
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State | ME
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Zip | 04072-2412
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Country | US
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Telephone | 646-331-4597
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Fax |
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Provider Business Mailing Address
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Address Line | 20 GARFIELD ST APT 11
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City | SACO
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State | ME
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Zip | 04072-2412
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Country | US
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Telephone | 646-331-4597
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JULIEN RUKUNDO SR.
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Credential |
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Telephone | 646-331-4597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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