=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528730967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACY HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2021
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 SE 25TH LOOP STE 103
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-421-5616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 S LAWRENCE BLVD
-----------------------------------------------------
City | KEYSTONE HEIGHTS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32656-9222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-478-7030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ELIZABETH MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-478-7030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------