Provider Demographics
NPI:1568690352
Name:LEGACY HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:LEGACY HOME CARE SERVICES, INC.
Other - Org Name:ALL SEASONS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:956-584-7444
Mailing Address - Street 1:6655 FIRST PARK TEN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4304
Mailing Address - Country:US
Mailing Address - Phone:956-584-7444
Mailing Address - Fax:956-584-8573
Practice Address - Street 1:3320 W ALBERTA RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9658
Practice Address - Country:US
Practice Address - Phone:956-584-7444
Practice Address - Fax:956-584-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010852251E00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747500Medicare Oscar/Certification