Provider Demographics
NPI:1174683312
Name:LEGACY HOSPICE, L.L.C
Entity Type:Organization
Organization Name:LEGACY HOSPICE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:ULIBARRI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-454-8099
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-0670
Mailing Address - Country:US
Mailing Address - Phone:505-454-8099
Mailing Address - Fax:505-454-8094
Practice Address - Street 1:2808 HOT SPRINGS BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-0670
Practice Address - Country:US
Practice Address - Phone:505-454-8099
Practice Address - Fax:505-454-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based