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General NPI Number Information
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NPI Number | 1831196328
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTH CARE, INC.
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 3135 N FAIRFIELD RD
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City | LAYTON
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State | UT
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Zip | 84041-8832
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Country | US
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Telephone | 801-771-9099
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Fax | 801-771-0200
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Provider Business Mailing Address
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Address Line | 3135 N FAIRFIELD RD
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City | LAYTON
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State | UT
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Zip | 84041-8832
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Country | US
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Telephone | 801-771-9099
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Fax | 801-771-0200
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | KEITH G GORDON
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Credential |
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Telephone | 801-771-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2005-HOSPICE-55836
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License Number State | UT
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