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General NPI Number Information
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NPI Number | 1538788237
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Entity Type | Organization
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Legal Business Name | LEGACY LIFE SOLUTIONS
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 197 ROUTE 18 STE 3000
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1440
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Country | US
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Telephone | 732-523-0769
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Fax |
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Provider Business Mailing Address
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Address Line | 197 ROUTE 18 STE 3000
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1440
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Country | US
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Telephone | 732-523-0769
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MAYRA MARTINEZ NEGRETE
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Credential |
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Telephone | 732-523-0769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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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 | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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