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General NPI Number Information
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NPI Number | 1437035615
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Entity Type | Organization
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Legal Business Name | A LIVING LEGACY
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3509 AMBASSADOR DR
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City | COLUMBUS
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State | GA
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Zip | 31907-2304
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Country | US
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Telephone | 706-289-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 AMBASSADOR DR
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City | COLUMBUS
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State | GA
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Zip | 31907-2304
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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 | OWNER
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Name | MARCIA WILSON
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Credential |
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Telephone | 706-289-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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