Provider Demographics
NPI:1528045671
Name:LEGACY HOMECARE, INC.
Entity Type:Organization
Organization Name:LEGACY HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHINGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-568-0162
Mailing Address - Street 1:11036 WASHINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3006
Mailing Address - Country:US
Mailing Address - Phone:562-568-0162
Mailing Address - Fax:562-568-0161
Practice Address - Street 1:11036 WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3006
Practice Address - Country:US
Practice Address - Phone:562-568-0162
Practice Address - Fax:562-568-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08137FMedicaid
CA058137Medicare UPIN
CA058137Medicare Oscar/Certification
CAHHA08137FMedicaid