Provider Demographics
NPI:1497080543
Name:THE LEGACY GROUP HOME HEALTH SERVICE
Entity Type:Organization
Organization Name:THE LEGACY GROUP HOME HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-447-2635
Mailing Address - Street 1:273 AZALEA ROAD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3669
Mailing Address - Country:US
Mailing Address - Phone:251-447-2635
Mailing Address - Fax:251-447-2637
Practice Address - Street 1:273 AZALEA ROAD
Practice Address - Street 2:SUITE 411
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3669
Practice Address - Country:US
Practice Address - Phone:251-447-2635
Practice Address - Fax:251-447-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health