Provider Demographics
NPI:1770817256
Name:LEGACY HOME HEALTH CARE OF SOUTHERN ARIZONA, LLC
Entity Type:Organization
Organization Name:LEGACY HOME HEALTH CARE OF SOUTHERN ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-335-6118
Mailing Address - Street 1:4996 E MEDITERRANEAN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2435
Mailing Address - Country:US
Mailing Address - Phone:520-335-6118
Mailing Address - Fax:520-335-6736
Practice Address - Street 1:4996 E MEDITERRANEAN DR
Practice Address - Street 2:SUITE D
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2435
Practice Address - Country:US
Practice Address - Phone:520-335-6118
Practice Address - Fax:520-335-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037099Medicare Oscar/Certification