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General NPI Number Information
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NPI Number | 1760100697
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Entity Type | Organization
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Legal Business Name | SOUTHERN LEGACY HOSPICE LLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 33300 EGYPT LN STE L800
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City | MAGNOLIA
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State | TX
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Zip | 77354-3322
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Country | US
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Telephone | 213-550-7205
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Fax |
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Provider Business Mailing Address
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Address Line | 33300 EGYPT LN STE L800
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City | MAGNOLIA
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State | TX
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Zip | 77354-3322
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Country | US
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Telephone | 213-550-7205
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Fax |
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Authorized Official
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Title or Position | ADM
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Name | MR. SAJID H SIDDIQUI
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Credential | DO
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Telephone | 213-550-7205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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