Provider Demographics
NPI:1639920077
Name:LU LEGACY HOMECARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:LU LEGACY HOMECARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCRETIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-509-4002
Mailing Address - Street 1:407 GABLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4167
Mailing Address - Country:US
Mailing Address - Phone:502-509-4002
Mailing Address - Fax:
Practice Address - Street 1:407 GABLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:COLDSTREAM
Practice Address - State:KY
Practice Address - Zip Code:40245-4167
Practice Address - Country:US
Practice Address - Phone:502-509-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care