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General NPI Number Information
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NPI Number | 1649883158
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Entity Type | Organization
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Legal Business Name | LEGACY PREMEIR HEALTHCARE SERVICES
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 213 22ND ST NE
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City | BRADENTON
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State | FL
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Zip | 34208-1631
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Country | US
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Telephone | 321-295-1314
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Fax |
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Provider Business Mailing Address
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Address Line | 581 N PARK AVE UNIT 2472
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City | APOPKA
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State | FL
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Zip | 32704-8707
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Country | US
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Telephone | 321-356-7792
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZARETTE MECHELLE PARKER
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Credential | RN
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Telephone | 321-295-1314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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