MEDICARE: LEGACY HEALTH AND WELLNESS, 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	251S00000X	Community/Behavioral Health Agency	E0435602012-5	NV

General Provider Information

NPI Number	:	1457600645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2921 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1409
Country	:	US
Telephone Number	:	702-338-8373
Fax Number	:	702-978-8001

Provider Business Practice Location Address
First Line	:	2921 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0381
Country	:	US
Telephone Number	:	702-942-1774
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. ABBY MARIE GROSSA
Credential	:
Telephone Number	:	702-338-8373

Provider Enumeration Date	:	09/03/2012
Last Update Date	:	01/04/2023

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