Provider Demographics
NPI:1396209268
Name:LEGACY CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:LEGACY CARE HOSPICE, INC.
Other - Org Name:SUNCREST HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-499-5358
Mailing Address - Street 1:36923 COOK ST STE 102-1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6073
Mailing Address - Country:US
Mailing Address - Phone:760-699-0053
Mailing Address - Fax:
Practice Address - Street 1:36923 COOK ST STE 102-1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6073
Practice Address - Country:US
Practice Address - Phone:760-699-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based