MEDICARE: LEGACY HEALTHCARE SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1215698287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	110 HORIZON DR STE 310
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-4926
Country	:	US
Telephone Number	:	910-724-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 WALTHER BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-5785
Country	:	US
Telephone Number	:	855-239-3467
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. WILLIAM G WILSON JR.
Credential	:
Telephone Number	:	919-424-5080

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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Directions to “LEGACY HEALTHCARE SERVICES INC ” Practice Location

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