Provider Demographics
NPI:1508581000
Name:LEGACY LIVING HOMES LLC
Entity Type:Organization
Organization Name:LEGACY LIVING HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-IN-TRAINOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-778-9999
Mailing Address - Street 1:11322 ERWIN RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4863
Mailing Address - Country:US
Mailing Address - Phone:704-778-9999
Mailing Address - Fax:
Practice Address - Street 1:3662 PATRICIA DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5625
Practice Address - Country:US
Practice Address - Phone:704-412-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home