Provider Demographics
NPI:1639152689
Name:LEGACY HOSPICE, L.L.C.
Entity Type:Organization
Organization Name:LEGACY HOSPICE, L.L.C.
Other - Org Name:CHOICE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-363-9932
Mailing Address - Street 1:6760 OLD JACKSONVILLE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0566
Mailing Address - Country:US
Mailing Address - Phone:903-363-9932
Mailing Address - Fax:903-509-5971
Practice Address - Street 1:107 W HOYT DR STE 101C
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3614
Practice Address - Country:US
Practice Address - Phone:903-667-1566
Practice Address - Fax:903-509-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008563251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015333OtherSTATE LICENSE
TX1012299Medicaid
TX015333OtherSTATE HHSC LICENSE