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General NPI Number Information
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NPI Number | 1528984598
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Entity Type | Organization
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Legal Business Name | REFINED LEGACY INC
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 3334 S SW LOOP 323 STE 119
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City | TYLER
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State | TX
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Zip | 75701-9237
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Country | US
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Telephone | 434-429-2944
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Fax |
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Provider Business Mailing Address
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Address Line | 3334 S SW LOOP 323 STE 119
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City | TYLER
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State | TX
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Zip | 75701-9237
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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 | CO-OWNER
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Name | DR. PHONESHIA WELLS
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Credential | DHED
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Telephone | 434-429-2944
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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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