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General NPI Number Information
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NPI Number | 1811857121
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Entity Type | Organization
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Legal Business Name | LEGACY ROOTS HOME CARE, LLC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 3379 PEACHTREE RD NE STE 700-740
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City | ATLANTA
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State | GA
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Zip | 30326-1031
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Country | US
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Telephone | 646-239-1395
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Fax | 646-239-1395
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Provider Business Mailing Address
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Address Line | 909 TAMARRON PKWY SE
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City | ATLANTA
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State | GA
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Zip | 30339-6769
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Country | US
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Telephone | 646-239-1395
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Fax | 646-239-1395
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Authorized Official
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Title or Position | ADMINISTRATOR / OWNER
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Name | KADIJAH PRINGLE-COTTERELL
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Credential |
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Telephone | 646-239-1395
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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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