MEDICARE: VISTA LEGACY CARE 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1871459362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA LEGACY CARE LLC

Provider Business Mailing Address
First Line	:	7006 TELFORD HOLLOW TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3590
Country	:	US
Telephone Number	:	832-805-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	7006 TELFORD HOLLOW TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3590
Country	:	US
Telephone Number	:	832-805-4740
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	AZKA ALI
Credential	:	MD
Telephone Number	:	832-805-4740

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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Directions to “VISTA LEGACY CARE LLC ” Practice Location

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