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General NPI Number Information
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NPI Number | 1558045351
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Entity Type | Organization
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Legal Business Name | L & W LEGACY ENTERPRISES
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 907 EDGEWATER DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-6711
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Country | US
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Telephone | 615-854-6283
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Fax |
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Provider Business Mailing Address
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Address Line | 907 EDGEWATER DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-6711
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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 | ADMINISTRATOR
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Name | RENEE ROBERTS
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Credential |
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Telephone | 615-854-6283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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