MEDICARE: LEGENDARY IN-HOME SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	374U00000X	Home Health Aide	MI
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265910038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGENDARY IN-HOME SERVICES

Provider Business Mailing Address
First Line	:	269 CHARLES LN
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-2930
Country	:	US
Telephone Number	:	313-757-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 CHARLES LN
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-2930
Country	:	US
Telephone Number	:	313-757-1843
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TENESIA GERMAN
Credential	:
Telephone Number	:	678-618-7932

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	11/18/2024

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