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General NPI Number Information
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NPI Number | 1871919654
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH & REHABILITATION, LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 9672 VIA EXCELENCIA STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92126-4573
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Country | US
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Telephone | 858-578-3700
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Fax | 858-345-3735
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Provider Business Mailing Address
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Address Line | 9672 VIA EXCELENCIA STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92126-4573
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Country | US
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Telephone | 858-254-0339
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Fax | 858-345-3735
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Authorized Official
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Title or Position | CEO
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Name | MRS. KATHERINE VICTA
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Credential | LVN
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Telephone | 858-578-3700
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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 | CA
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