MEDICARE: LEGACY HOME HEALTH CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1154165058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1582 S PARKER RD STE 108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2715
Country	:	US
Telephone Number	:	720-428-8490
Fax Number	:	720-242-7057

Provider Business Practice Location Address
First Line	:	1582 S PARKER RD STE 108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2715
Country	:	US
Telephone Number	:	720-428-8490
Fax Number	:	720-242-7057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMED ABDI
Credential	:
Telephone Number	:	720-428-8490

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/25/2024

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Directions to “LEGACY HOME HEALTH CARE LLC ” Practice Location

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