Provider Demographics
NPI:1619757994
Name:LEGACY CARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:LEGACY CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-840-0708
Mailing Address - Street 1:27919 GENESIS MANOR LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6252
Mailing Address - Country:US
Mailing Address - Phone:832-840-0708
Mailing Address - Fax:
Practice Address - Street 1:27919 GENESIS MANOR LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6252
Practice Address - Country:US
Practice Address - Phone:832-840-0708
Practice Address - Fax:832-263-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care