Provider Demographics
NPI:1972103778
Name:LEGACY HOUSE CALLS LLC
Entity Type:Organization
Organization Name:LEGACY HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILOMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-767-4074
Mailing Address - Street 1:2205 EDINBURGH WAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-1139
Mailing Address - Country:US
Mailing Address - Phone:469-767-4074
Mailing Address - Fax:
Practice Address - Street 1:2205 EDINBURGH WAY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1139
Practice Address - Country:US
Practice Address - Phone:469-767-4074
Practice Address - Fax:214-227-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty