Provider Demographics
NPI:1033405956
Name:LEGACY VALLEY HOSPICE CARE LLC
Entity Type:Organization
Organization Name:LEGACY VALLEY HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-855-0848
Mailing Address - Street 1:PO BOX 60650
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0650
Mailing Address - Country:US
Mailing Address - Phone:361-855-0848
Mailing Address - Fax:361-854-6795
Practice Address - Street 1:3605 PLANTATION GROVE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7604
Practice Address - Country:US
Practice Address - Phone:361-855-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based