Provider Demographics
NPI:1851935944
Name:LEGEND PROVIDER SERVICES, INC
Entity Type:Organization
Organization Name:LEGEND PROVIDER SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-948-5446
Mailing Address - Street 1:8700 COMMERCE PARK DR STE 146
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:281-948-2554
Mailing Address - Fax:
Practice Address - Street 1:8700 COMMERCE PARK DR STE 146
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:281-948-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health