Provider Demographics
NPI:1003703463
Name:LEGACY PROVIDER SERVICES
Entity type:Organization
Organization Name:LEGACY PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-474-5916
Mailing Address - Street 1:1600 JOLLA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3005
Mailing Address - Country:US
Mailing Address - Phone:915-474-5916
Mailing Address - Fax:
Practice Address - Street 1:1600 JOLLA DEL SOL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3005
Practice Address - Country:US
Practice Address - Phone:915-474-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health