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General NPI Number Information
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NPI Number | 1861852618
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 6410 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2015
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Country | US
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Telephone | 414-930-0464
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Fax | 414-930-0493
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Provider Business Mailing Address
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Address Line | 6410 W NORTH AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2015
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Country | US
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Telephone | 414-930-0464
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Fax | 414-930-0493
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ONTARIUS BELL
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Credential |
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Telephone | 414-460-7971
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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 | WI
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