Provider Demographics
NPI:1235459058
Name:LEGACY HEALTH SERVICES
Entity Type:Organization
Organization Name:LEGACY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1866-974-5559
Mailing Address - Street 1:1915 NORTH MARTIN LUTHER KING JR. DRIVE
Mailing Address - Street 2:SUITE #240W BOX #35
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3676
Mailing Address - Country:US
Mailing Address - Phone:866-974-5559
Mailing Address - Fax:414-302-5060
Practice Address - Street 1:1915 N. MLK JR. DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3676
Practice Address - Country:US
Practice Address - Phone:866-974-5559
Practice Address - Fax:414-302-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management