Provider Demographics
NPI:1568777803
Name:HOUSTON LEGACY GROUP
Entity Type:Organization
Organization Name:HOUSTON LEGACY GROUP
Other - Org Name:INTERIM HEALTHCARE - TEXAS BAY AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BOZEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-309-9001
Mailing Address - Street 1:646 FM 517 RD WEST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539
Mailing Address - Country:US
Mailing Address - Phone:281-309-9001
Mailing Address - Fax:281-309-9000
Practice Address - Street 1:646 FM 517 RD WEST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:281-309-9001
Practice Address - Fax:281-309-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679673Medicare UPIN