MEDICARE: LEGACY HELPERS 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1013652627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HELPERS LLC

Provider Business Mailing Address
First Line	:	210 4TH ST
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-2918
Country	:	US
Telephone Number	:	732-768-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 4TH ST
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-2918
Country	:	US
Telephone Number	:	732-768-7227
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LEEANN MOORE
Credential	:
Telephone Number	:	732-768-7227

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	09/18/2023

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