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General NPI Number Information
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NPI Number | 1942174735
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Entity Type | Organization
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Legal Business Name | KJC LEGACY LLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 3515 MANCHESTER RD STE F
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City | COVENTRY TOWNSHIP
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State | OH
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Zip | 44319-1466
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Country | US
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Telephone | 330-599-7316
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Fax | 330-599-7318
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Provider Business Mailing Address
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Address Line | 3515 MANCHESTER RD STE F
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City | COVENTRY TOWNSHIP
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State | OH
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Zip | 44319-1466
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Country | US
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Telephone | 330-599-7316
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Fax | 330-599-7318
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Authorized Official
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Title or Position | OWNER, CEO
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Name | KELLY MERRIE MEISER
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Credential | LPN, LNHA-HSE
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Telephone | 330-599-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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