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General NPI Number Information
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NPI Number | 1922429422
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 1748 KINSAUL WILLOUGHBY RD
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City | GREENVILLE
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State | NC
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Zip | 27834-7157
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Country | US
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Telephone | 252-864-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 KINSAUL WILLOUGHBY RD
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City | GREENVILLE
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State | NC
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Zip | 27834-7157
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Country | US
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Telephone | 252-864-3532
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | ANGELA GRANT
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Credential |
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Telephone | 919-424-5086
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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 | 1421
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1421
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1421
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License Number State | NC
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