Provider Demographics
NPI:1568797710
Name:ARCHES LEGACY, LLC
Entity Type:Organization
Organization Name:ARCHES LEGACY, LLC
Other - Org Name:LEGACY HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-443-9331
Mailing Address - Street 1:3636 CROSSINGS DR STE C
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7190
Mailing Address - Country:US
Mailing Address - Phone:928-443-9331
Mailing Address - Fax:928-443-9332
Practice Address - Street 1:3636 CROSSINGS DR STE C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7190
Practice Address - Country:US
Practice Address - Phone:928-443-9331
Practice Address - Fax:928-443-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037247Medicare UPIN