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General NPI Number Information
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NPI Number | 1790495612
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Entity Type | Organization
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Legal Business Name | LONESTAR LEGACY CARE, LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 983 WHITEHEAD DR STE 106
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City | GRANBURY
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State | TX
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Zip | 76048-1463
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Country | US
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Telephone | 682-205-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 983 WHITEHEAD DR STE 106
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City | GRANBURY
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State | TX
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Zip | 76048-1463
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Country | US
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Telephone | 682-205-3366
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | ERIC DENSON
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Credential |
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Telephone | 920-840-4851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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