Provider Demographics
NPI:1609345362
Name:LEGACY CHRISTIAN HOME HEALTHCARE
Entity Type:Organization
Organization Name:LEGACY CHRISTIAN HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-718-8781
Mailing Address - Street 1:11836 SOUTH AVE UNIT 22
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8593
Mailing Address - Country:US
Mailing Address - Phone:330-718-8781
Mailing Address - Fax:
Practice Address - Street 1:11836 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8588
Practice Address - Country:US
Practice Address - Phone:330-718-8781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY CHRISTIAN HOME HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care