Provider Demographics
NPI:1508204413
Name:LEGACY HEALTHCARE SOLUTIONS
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIQUITA
Authorized Official - Middle Name:CHARMAINE
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-603-1605
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:BACONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31716-0213
Mailing Address - Country:US
Mailing Address - Phone:229-603-1605
Mailing Address - Fax:
Practice Address - Street 1:318 SOUTH RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:BACONTON
Practice Address - State:GA
Practice Address - Zip Code:31716-0213
Practice Address - Country:US
Practice Address - Phone:229-603-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care