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General NPI Number Information
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NPI Number | 1902149776
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Entity Type | Organization
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Legal Business Name | LEGACY CARE LLC
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 123 S LYNNHAVEN RD STE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7401
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Country | US
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Telephone | 757-536-2246
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 645986
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City | PITTSBURGH
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State | PA
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Zip | 15264-5257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DESI-RAE HALL
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Credential |
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Telephone | 757-251-9419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | VA
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