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NPI Code Detail

MEDICARE: LPS LEGACY ENTERPRISES LLC

MEDICARE: LPS LEGACY ENTERPRISES 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1881323889
Entity Type Code : Organization
Provider Name (Legal Business Name) : LPS LEGACY ENTERPRISES LLC
Provider Business Mailing Address
First Line : 4023 CLUB MANOR DR
Second Line :
City : PUEBLO
State : CO
Zip : 81008-2004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4023 CLUB MANOR DR
Second Line :
City : PUEBLO
State : CO
Zip : 81008-2004
Country : US
Telephone Number : 719-671-2362
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BAMBI CREEK
Credential :
Telephone Number : 719-671-2362
Provider Enumeration Date : 06/07/2022
Last Update Date : 06/07/2022

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Directions to “LPS LEGACY ENTERPRISES LLC ” Practice Location

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