Provider Demographics
NPI:1417260357
Name:LEGACY FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:LEGACY FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDON-WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-908-7374
Mailing Address - Street 1:6033 BONNEAU RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2008
Mailing Address - Country:US
Mailing Address - Phone:804-908-7374
Mailing Address - Fax:804-354-6006
Practice Address - Street 1:8385 CARDOVA CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1548
Practice Address - Country:US
Practice Address - Phone:804-908-7374
Practice Address - Fax:804-354-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1212-01-001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities