Provider Demographics
NPI:1437188117
Name:LEGACY INTERNATIONAL SERVICES COMPANY INC
Entity Type:Organization
Organization Name:LEGACY INTERNATIONAL SERVICES COMPANY INC
Other - Org Name:LEGACY HOME HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP - TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA NENITA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAYAGDAG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:708-447-9273
Mailing Address - Street 1:4747 W PETERSON AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5712
Mailing Address - Country:US
Mailing Address - Phone:708-447-9273
Mailing Address - Fax:708-447-9275
Practice Address - Street 1:4747 W PETERSON AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5712
Practice Address - Country:US
Practice Address - Phone:708-447-9273
Practice Address - Fax:708-447-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010302251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid