Provider Demographics
NPI:1508556457
Name:LIVING LEGACY LLC
Entity Type:Organization
Organization Name:LIVING LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:LADEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:205-899-1747
Mailing Address - Street 1:2116 29TH AVE N APT C
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-5052
Mailing Address - Country:US
Mailing Address - Phone:205-899-1747
Mailing Address - Fax:
Practice Address - Street 1:2116 29TH AVE N APT C
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-5052
Practice Address - Country:US
Practice Address - Phone:205-899-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA