MEDICARE: THE LEGACY CARE HOME

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861342081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LEGACY CARE HOME

Provider Business Mailing Address
First Line	:	305 N SHAVER ST
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28144-5156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 ARDEN RD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28144-2112
Country	:	US
Telephone Number	:	980-234-6170
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA L PHIFER
Credential	:
Telephone Number	:	980-234-6170

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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Directions to “THE LEGACY CARE HOME ” Practice Location

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