MEDICARE: LEGACY HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710504329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1100 SHAWNEE RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-3529
Country	:	US
Telephone Number	:	419-999-2010
Fax Number	:	419-999-6284

Provider Business Practice Location Address
First Line	:	2615 FORT AMANDA RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-3704
Country	:	US
Telephone Number	:	419-999-2010
Fax Number	:	419-999-6284

Authorized Official
Title or Position	:	VICE PRESIDENT - FIANANCE & CFO
Name	:	CHAD M. UNVERFERTH
Credential	:
Telephone Number	:	419-999-2010

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	07/10/2023

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Directions to “LEGACY HOSPICE, INC. ” Practice Location

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