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General NPI Number Information
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NPI Number | 1508581000
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Entity Type | Organization
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Legal Business Name | LEGACY LIVING HOMES LLC
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 3662 PATRICIA DR NW
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City | CONCORD
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State | NC
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Zip | 28027-5625
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Country | US
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Telephone | 704-412-9906
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Fax |
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Provider Business Mailing Address
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Address Line | 11322 ERWIN RIDGE AVE
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City | CHARLOTTE
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State | NC
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Zip | 28213-4863
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Country | US
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Telephone | 704-778-9999
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR-IN-TRAINOR
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Name | LORENZO MCNULTY
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Credential |
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Telephone | 704-778-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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