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NPI Code Detail

MEDICARE: LEGACY HEALTHCARE SERVICES INC

MEDICARE: LEGACY HEALTHCARE SERVICES 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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1730756313
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGACY HEALTHCARE SERVICES INC
Provider Business Mailing Address
First Line : 110 HORIZON DR STE 310
Second Line :
City : RALEIGH
State : NC
Zip : 27615-4926
Country : US
Telephone Number : 919-424-5080
Fax Number :
Provider Business Practice Location Address
First Line : 2255 CANDIES LN NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-2661
Country : US
Telephone Number : 855-239-3467
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. WILLIAM GIL WILSON JR.
Credential :
Telephone Number : 919-424-5080
Provider Enumeration Date : 06/10/2021
Last Update Date : 08/06/2021

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Directions to “LEGACY HEALTHCARE SERVICES INC ” Practice Location

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