Provider Demographics
NPI:1326630104
Name:LEGACY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-309-5661
Mailing Address - Street 1:1070 A ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4106
Mailing Address - Country:US
Mailing Address - Phone:510-952-9906
Mailing Address - Fax:510-952-9927
Practice Address - Street 1:1070 A ST STE 5
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4106
Practice Address - Country:US
Practice Address - Phone:510-952-9906
Practice Address - Fax:510-952-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based