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General NPI Number Information
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NPI Number | 1841157245
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Entity Type | Organization
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Legal Business Name | LEGACY BRIDGE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2615 MEDICAL CENTER PKWY
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City | MURFREESBORO
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State | TN
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Zip | 37129-2261
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Country | US
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Telephone | 615-318-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 311 S BILBRO AVE
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City | MURFREESBORO
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State | TN
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Zip | 37130-4417
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Country | US
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Telephone | 615-987-2523
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO/EXECUTIVE DIRECTOR
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Name | KANESHA FRAZIER
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Credential |
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Telephone | 615-987-2523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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