Provider Demographics
NPI:1225349376
Name:THE LEGACY AT HOME, INC.
Entity Type:Organization
Organization Name:THE LEGACY AT HOME, INC.
Other - Org Name:LEGACY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-244-7700
Mailing Address - Street 1:8080 INDEPENDENCE PKWY
Mailing Address - Street 2:STE 245
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4000
Mailing Address - Country:US
Mailing Address - Phone:972-244-7700
Mailing Address - Fax:972-244-7701
Practice Address - Street 1:6101 OHIO DR STE 100B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2720
Practice Address - Country:US
Practice Address - Phone:972-244-7700
Practice Address - Fax:972-244-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX013810OtherAGENCY PARENT LICENSE
TX013810OtherAGENCY BRANCH LICENSE