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General NPI Number Information
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NPI Number | 1447635289
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH CARE OF SOUTHERN ARIZONA, LLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 1491 W THATCHER BLVD SUITE 104
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City | SAFFORD
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State | AZ
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Zip | 85546-3362
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Country | US
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Telephone | 520-335-6118
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Fax | 888-504-1425
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Provider Business Mailing Address
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Address Line | 4996 E MEDITERRANEAN DR STE D
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2435
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Country | US
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Telephone | 520-335-6118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH MAILLARD
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Credential | MBA
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Telephone | 928-632-2373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA7638
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License Number State | AZ
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