Provider Demographics
NPI:1114690906
Name:FAMILY LEGACY HOME HEALTH CARE
Entity Type:Organization
Organization Name:FAMILY LEGACY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:AM
Authorized Official - Phone:314-651-7172
Mailing Address - Street 1:12633 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4618
Mailing Address - Country:US
Mailing Address - Phone:314-651-7172
Mailing Address - Fax:314-653-0258
Practice Address - Street 1:12633 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4618
Practice Address - Country:US
Practice Address - Phone:314-651-7172
Practice Address - Fax:314-653-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health