Provider Demographics
NPI:1467536151
Name:LEGACY HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LEGACY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-443-9331
Mailing Address - Street 1:3607 CROSSINGS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7149
Mailing Address - Country:US
Mailing Address - Phone:928-443-9331
Mailing Address - Fax:928-443-9332
Practice Address - Street 1:3607 CROSSINGS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7149
Practice Address - Country:US
Practice Address - Phone:928-443-9331
Practice Address - Fax:928-443-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health