MEDICARE: LEGACY CATERING GROUP

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	174200000X	Meals Provider
2	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1154247377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY CATERING GROUP

Provider Business Mailing Address
First Line	:	7737 NW 187TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7737 NW 187TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5248
Country	:	US
Telephone Number	:	305-439-7407
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOMALI HERRERA
Credential	:
Telephone Number	:	305-439-7407

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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