Provider Demographics
NPI:1679231187
Name:LEGACY ALLIED HEALTH LLC
Entity Type:Organization
Organization Name:LEGACY ALLIED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIKA
Authorized Official - Middle Name:QUINTEL
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-590-2962
Mailing Address - Street 1:PO BOX 191904
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72219-1904
Mailing Address - Country:US
Mailing Address - Phone:501-414-2590
Mailing Address - Fax:
Practice Address - Street 1:43 WARREN DR APT 22
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7602
Practice Address - Country:US
Practice Address - Phone:501-414-2590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health