Provider Demographics
NPI:1174274245
Name:LEGACY HOME HEALTH LLC
Entity Type:Organization
Organization Name:LEGACY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CIERRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BILLINGSLEA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-554-4684
Mailing Address - Street 1:2631 TREEHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2580
Mailing Address - Country:US
Mailing Address - Phone:904-554-4684
Mailing Address - Fax:
Practice Address - Street 1:2631 TREEHOUSE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2580
Practice Address - Country:US
Practice Address - Phone:904-554-4684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care