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General NPI Number Information
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NPI Number | 1467655761
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE SERVICES, INC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 2270 PARK HILLS DR
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City | FAIRBORN
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State | OH
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Zip | 45324-3993
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Country | US
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Telephone | 937-754-9820
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27616-2817
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Country | US
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Telephone | 919-424-5080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA HOSKINS
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Credential |
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Telephone | 919-424-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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