Provider Demographics
NPI:1891859609
Name:LEGUM HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:LEGUM HOME HEALTH CARE, INC
Other - Org Name:HOME IV CARE AND NUTRITIONAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-932-3000
Mailing Address - Street 1:30 EBCO CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7344
Mailing Address - Country:US
Mailing Address - Phone:540-932-3000
Mailing Address - Fax:540-932-3028
Practice Address - Street 1:30 EBCO CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-7344
Practice Address - Country:US
Practice Address - Phone:540-932-3000
Practice Address - Fax:540-932-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0563960001Medicare ID - Type Unspecified