MEDICARE: LEGACY OF MEMPHIS HOMECARE CORPORATION

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

General Provider Information

NPI Number	:	1558154906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY OF MEMPHIS HOMECARE CORPORATION

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-779-8064
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE STE 405
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3633
Country	:	US
Telephone Number	:	901-779-8064
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MRS. ANDREA HODGES
Credential	:
Telephone Number	:	901-779-8064

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/29/2025

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