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General NPI Number Information
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NPI Number | 1891450854
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY HOME CARE
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 405 BIRT AVE
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City | NEW CASTLE
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State | PA
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Zip | 16101-1901
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Country | US
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Telephone | 724-510-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 405 BIRT AVE
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City | NEW CASTLE
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State | PA
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Zip | 16101-1901
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Country | US
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Telephone | 724-510-4150
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JA'VONNA MOSS
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Credential |
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Telephone | 724-510-4150
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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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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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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 | 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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