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NPI Code Detail

MEDICARE: LEGACY GENERATION INCORPORATED

MEDICARE: LEGACY GENERATION INCORPORATED
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
1253Z00000XIn Home Supportive Care AgencyNC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HC4364OTHERNCNC DHSR
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336446665
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY GENERATION INCORPORATED
Provider Business Mailing Address
First Line : 11012 PARKLEIGH DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-4461
Country : US
Telephone Number : 704-764-1818
Fax Number : 704-764-1817
Provider Business Practice Location Address
First Line : 5960 FAIRVIEW RD
Second Line : SUITE 400
City : CHARLOTTE
State : NC
Zip : 28210-3119
Country : US
Telephone Number : 704-764-1818
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. MAURICE A BARNES
Credential :
Telephone Number : 704-764-1819
Provider Enumeration Date : 02/23/2011
Last Update Date : 02/10/2014

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Directions to “LEGACY GENERATION INCORPORATED ” Practice Location

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