Provider Demographics
NPI:1619560042
Name:LEGACY PLUS HOME HEALTH
Entity Type:Organization
Organization Name:LEGACY PLUS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-817-7568
Mailing Address - Street 1:27010 CARLYSLE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2554
Mailing Address - Country:US
Mailing Address - Phone:313-817-7568
Mailing Address - Fax:313-633-0152
Practice Address - Street 1:27010 CARLYSLE ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2554
Practice Address - Country:US
Practice Address - Phone:313-817-7568
Practice Address - Fax:313-633-0152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY PLUS HOME CARE AGENCY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health