Provider Demographics
NPI:1073195673
Name:LEGACY CARE LLC.
Entity Type:Organization
Organization Name:LEGACY CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:918-378-9258
Mailing Address - Street 1:6742 E 91ST PL APT 3
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5395
Mailing Address - Country:US
Mailing Address - Phone:918-378-9258
Mailing Address - Fax:
Practice Address - Street 1:9125 S SHERIDAN RD STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5330
Practice Address - Country:US
Practice Address - Phone:918-378-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health