MEDICARE: LEGACY PATH HOME CARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376401885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY PATH HOME CARE LLC

Provider Business Mailing Address
First Line	:	6030 W RIVIERA DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2520
Country	:	US
Telephone Number	:	602-772-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	6030 W RIVIERA DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2520
Country	:	US
Telephone Number	:	602-772-7051
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AHMED DFAALLA
Credential	:
Telephone Number	:	602-772-7051

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “LEGACY PATH HOME CARE LLC ” Practice Location

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