MEDICARE: LEGACY HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	17J598	OTHER		LICENSE

General Provider Information

NPI Number	:	1003044835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HOSPICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	380 PERRY ST STE 210
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-2485
Country	:	US
Telephone Number	:	303-660-6107
Fax Number	:	888-660-6107

Authorized Official
Title or Position	:	VP LICENSURE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	913-814-2013

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	04/07/2026

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Directions to “LEGACY HOSPICE LLC ” Practice Location

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