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General NPI Number Information
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NPI Number | 1952876245
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Entity Type | Organization
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Legal Business Name | LEGACY HOME HEALTH, LLC
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 140 N 100 E
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1735
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Country | US
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Telephone | 801-805-0199
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Fax | 801-820-7702
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Provider Business Mailing Address
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Address Line | 140 N 100 E
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1735
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Country | US
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Telephone | 801-805-0199
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Fax | 801-820-7702
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. NATHAN JOHNS
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Credential |
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Telephone | 801-805-0199
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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 |
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License Number State |
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