Provider Demographics
NPI:1407515687
Name:LEGACY U HEALTH CARE CONSULTING & TRAINING CENTER
Entity Type:Organization
Organization Name:LEGACY U HEALTH CARE CONSULTING & TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONICA
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:191-951-6922
Mailing Address - Street 1:3900 MERTON DR STE 250
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6636
Mailing Address - Country:US
Mailing Address - Phone:252-258-5093
Mailing Address - Fax:919-964-3105
Practice Address - Street 1:3900 MERTON DR STE 250
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6636
Practice Address - Country:US
Practice Address - Phone:252-258-5093
Practice Address - Fax:919-964-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC201922000641-1OtherNC SECRETARY OF STATE- ARTICLES OF INCORPORATION
NC1074OtherNC BOARD OF NURSING - CERTIFICATE OF PLLC
NC34D2013034OtherDEPARTMENT OF HEALTH & HUMAN SERVICES - CLIA WAIVER