Provider Demographics
NPI:1417687294
Name:LEGACY EMPOWERMENT SERVICES LLC
Entity Type:Organization
Organization Name:LEGACY EMPOWERMENT SERVICES LLC
Other - Org Name:LEGACY LIFE SOLUTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-523-0769
Mailing Address - Street 1:110 FIELDCREST AVE
Mailing Address - Street 2:3RD FLOOR,
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837
Mailing Address - Country:US
Mailing Address - Phone:732-523-0769
Mailing Address - Fax:
Practice Address - Street 1:110 FIELDCREST AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837
Practice Address - Country:US
Practice Address - Phone:732-523-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty