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General NPI Number Information
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NPI Number | 1912834243
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Entity Type | Organization
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Legal Business Name | LASTING LEGACY HOME CARE LLC
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 463688 STATE ROAD 200 STE 1522
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City | YULEE
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State | FL
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Zip | 32097-0304
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Country | US
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Telephone | 904-849-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 81508 BOATSWAIN CT
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-7118
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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 | OWNER
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Name | HENRY BOLTON JR.
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Credential |
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Telephone | 706-564-1472
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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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