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General NPI Number Information
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NPI Number | 1891511721
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Entity Type | Organization
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Legal Business Name | LEGACY AT HOME LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 302 PLEASANT VIEW DR
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-9262
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Country | US
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Telephone | 610-858-7410
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Fax | 484-363-5923
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Provider Business Mailing Address
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Address Line | 302 PLEASANT VIEW DR
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-9262
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Country | US
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Telephone | 610-858-7410
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Fax | 484-363-5923
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. REGINA TENDAYI
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Credential | DR.
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Telephone | 610-858-7410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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