=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558298281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGACY LIVING HC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2026
-----------------------------------------------------
Last Update Date | 05/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4444 BROADWAY STE A5
-----------------------------------------------------
City | GARY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46408-3364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-575-9274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4444 BROADWAY STE A5
-----------------------------------------------------
City | GARY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46408-3364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-575-9274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAVOUYA TERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-846-0283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------