MEDICARE: LEGACY LIFE FAMILY SUPPORT PROFESSIONALS INC.

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	:	1235087388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY LIFE FAMILY SUPPORT PROFESSIONALS INC.

Provider Business Mailing Address
First Line	:	1800 N MCCORD RD APT 94
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3073
Country	:	US
Telephone Number	:	567-416-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N MCCORD RD APT 94
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3073
Country	:	US
Telephone Number	:	567-416-8001
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN MARQUISE WILLIAMS-EL
Credential	:	DSP
Telephone Number	:	567-416-8001

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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