Provider Demographics
NPI:1710459276
Name:LEGACY HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIKIRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DISU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-505-6980
Mailing Address - Street 1:2555 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4041
Mailing Address - Country:US
Mailing Address - Phone:240-505-6980
Mailing Address - Fax:
Practice Address - Street 1:2555 MADISON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4041
Practice Address - Country:US
Practice Address - Phone:240-505-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care