MEDICARE: LEGACY ALLIED HEALTH 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

General Provider Information

NPI Number	:	1679231187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY ALLIED HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 191904
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72219-1904
Country	:	US
Telephone Number	:	501-414-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 WARREN DR APT 22
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7602
Country	:	US
Telephone Number	:	501-414-2590
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	SHERIKA QUINTEL LAMB
Credential	:
Telephone Number	:	501-590-2962

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/09/2021

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