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General NPI Number Information
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NPI Number | 1710262001
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Entity Type | Organization
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Legal Business Name | LEGEND HOME HEALTH, INC.
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 3510 TORRANCE BLVD STE 111
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City | TORRANCE
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State | CA
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Zip | 90503-4814
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Country | US
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Telephone | 310-540-4059
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Fax | 310-540-4074
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Provider Business Mailing Address
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Address Line | 3510 TORRANCE BLVD STE 111
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City | TORRANCE
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State | CA
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Zip | 90503-4814
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Country | US
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Telephone | 310-540-4059
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Fax | 310-540-4074
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANGELIQUE GRADNEY
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Credential |
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Telephone | 310-540-4059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 550002040
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License Number State | CA
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