Provider Demographics
NPI:1144116328
Name:LEGACY SIGNATURE GROUP
Entity type:Organization
Organization Name:LEGACY SIGNATURE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEKRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-498-0254
Mailing Address - Street 1:7506 MONARCH FOREST LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2434
Mailing Address - Country:US
Mailing Address - Phone:260-498-0254
Mailing Address - Fax:
Practice Address - Street 1:7506 MONARCH FOREST LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2434
Practice Address - Country:US
Practice Address - Phone:260-498-0254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No251E00000XAgenciesHome Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty