MEDICARE: LEGACY INTERNATIONAL SERVICES COMPANY 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	1010302	IL

General Provider Information

NPI Number	:	1437188117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY INTERNATIONAL SERVICES COMPANY INC

Provider Business Mailing Address
First Line	:	4747 W PETERSON AVE
Second Line	:	SUITE 311
City	:	CHICAGO
State	:	IL
Zip	:	60646-5712
Country	:	US
Telephone Number	:	708-447-9273
Fax Number	:	708-447-9275

Provider Business Practice Location Address
First Line	:	4747 W PETERSON AVE
Second Line	:	SUITE 311
City	:	CHICAGO
State	:	IL
Zip	:	60646-5712
Country	:	US
Telephone Number	:	708-447-9273
Fax Number	:	708-447-9275

Authorized Official
Title or Position	:	VP - TREASURER
Name	:	MRS. MARIA NENITA T DAYAGDAG
Credential	:	M.B.A.
Telephone Number	:	708-447-9273

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/09/2009

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Directions to “LEGACY INTERNATIONAL SERVICES COMPANY INC ” Practice Location

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