Provider Demographics
NPI:1710262001
Name:LEGEND HOME HEALTH, INC.
Entity Type:Organization
Organization Name:LEGEND HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-540-4059
Mailing Address - Street 1:3510 TORRANCE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4814
Mailing Address - Country:US
Mailing Address - Phone:310-540-4059
Mailing Address - Fax:310-540-4074
Practice Address - Street 1:3510 TORRANCE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4814
Practice Address - Country:US
Practice Address - Phone:310-540-4059
Practice Address - Fax:310-540-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002040251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059578Medicare Oscar/Certification