Provider Demographics
NPI:1881024826
Name:LEGACY HEALTHCARE INC.
Entity Type:Organization
Organization Name:LEGACY HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-338-3702
Mailing Address - Street 1:3610 BOSQUE PLZ NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4295
Mailing Address - Country:US
Mailing Address - Phone:505-338-3702
Mailing Address - Fax:505-338-3709
Practice Address - Street 1:3610 BOSQUE PLZ NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4295
Practice Address - Country:US
Practice Address - Phone:505-338-3702
Practice Address - Fax:505-338-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based