Provider Demographics
NPI:1497095228
Name:LEGACY HEALTH & WELLNESS
Entity Type:Organization
Organization Name:LEGACY HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-942-1774
Mailing Address - Street 1:911 N BUFFALO DR
Mailing Address - Street 2:213
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0379
Mailing Address - Country:US
Mailing Address - Phone:702-942-1774
Mailing Address - Fax:702-942-1773
Practice Address - Street 1:911 N BUFFALO DR
Practice Address - Street 2:213
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0379
Practice Address - Country:US
Practice Address - Phone:702-942-1774
Practice Address - Fax:702-942-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty