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General NPI Number Information
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NPI Number | 1730488131
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Entity Type | Organization
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Legal Business Name | LEGACY HOMECARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 106 N CEDAR ST
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City | PAULS VALLEY
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State | OK
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Zip | 73075-2805
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Country | US
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Telephone | 405-207-9496
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Fax | 405-207-9701
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Provider Business Mailing Address
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Address Line | 2411 SPRINGER DR
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City | NORMAN
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State | OK
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Zip | 73069-3955
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Country | US
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Telephone | 405-329-4545
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KAREN E VAHLBERG
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Credential | RN
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Telephone | 405-329-4545
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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 |
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License Number State |
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