Provider Demographics
NPI:1154847515
Name:LEGACY COMMUNITY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:LEGACY COMMUNITY HEALTH SERVICES, INC
Other - Org Name:LEGACY COMMUNITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GURWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-826-9866
Mailing Address - Street 1:3811 LYONS AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020
Mailing Address - Country:US
Mailing Address - Phone:713-366-7400
Mailing Address - Fax:713-559-3269
Practice Address - Street 1:3811 LYONS AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020
Practice Address - Country:US
Practice Address - Phone:713-366-7400
Practice Address - Fax:713-559-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
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