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General NPI Number Information
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NPI Number | 1629301130
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE SERVICES
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 1315 GREENSBORO RD
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City | HIGH POINT
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State | NC
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Zip | 27260-2611
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Country | US
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Telephone | 133-682-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27616-2815
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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 | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. MANAL ALAN FAKHOURY
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Credential | M.A., CFY-SLP
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Telephone | 919-306-1847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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