MEDICARE: OUR LEGACY VENTURES 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	251E00000X	Home Health Agency	HCO-339PC	VA

General Provider Information

NPI Number	:	1649473307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LEGACY VENTURES LLC

Provider Business Mailing Address
First Line	:	4901 FITZHUGH AVE
Second Line	:	SUITE 201
City	:	RICHMOND
State	:	VA
Zip	:	23230-3531
Country	:	US
Telephone Number	:	804-644-1076
Fax Number	:	804-644-4005

Provider Business Practice Location Address
First Line	:	4901 FITZHUGH AVE
Second Line	:	SUITE 201
City	:	RICHMOND
State	:	VA
Zip	:	23230-3531
Country	:	US
Telephone Number	:	804-644-1076
Fax Number	:	804-644-4005

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. LINWOOD ANTHONY CARTER
Credential	:
Telephone Number	:	804-644-1076

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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