Provider Demographics
NPI:1730488131
Name:LEGACY HOMECARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LEGACY HOMECARE ASSOCIATES, LLC
Other - Org Name:LIFESPRING HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-329-4545
Mailing Address - Street 1:2411 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3955
Mailing Address - Country:US
Mailing Address - Phone:405-329-4545
Mailing Address - Fax:
Practice Address - Street 1:106 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-2805
Practice Address - Country:US
Practice Address - Phone:405-207-9496
Practice Address - Fax:405-207-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377757OtherMEDICARE PTAN