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NPI Code Detail

MEDICARE: LEGACY HOSPICE, LLC

MEDICARE: LEGACY HOSPICE, 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
1251G00000XCommunity Based Hospice Care Agency008563TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1015333OTHERTXSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3015333OTHERTXSTATE HHSC LICENSE

General Provider Information

NPI Number : 1639152689
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY HOSPICE, LLC
Provider Business Mailing Address
First Line : 6770 OLD JACKSONVILLE HWY STE 102A
Second Line :
City : TYLER
State : TX
Zip : 75703-0576
Country : US
Telephone Number : 903-509-3015
Fax Number : 903-509-5971
Provider Business Practice Location Address
First Line : 107 W HOYT DR STE 101C
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-3614
Country : US
Telephone Number : 903-667-1566
Fax Number : 903-509-5971
Authorized Official
Title or Position : SECRETARY
Name : KATRINA DAWN LANIER
Credential :
Telephone Number : 903-932-1852
Provider Enumeration Date : 11/23/2005
Last Update Date : 05/07/2026

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Directions to “LEGACY HOSPICE, LLC ” Practice Location

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