Provider Demographics
NPI:1972256709
Name:UNIVERSAL LEGACY HEALTHCARE LLC
Entity Type:Organization
Organization Name:UNIVERSAL LEGACY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-449-3957
Mailing Address - Street 1:9115 SURREY GATE PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9280
Mailing Address - Country:US
Mailing Address - Phone:937-449-3957
Mailing Address - Fax:
Practice Address - Street 1:9115 SURREY GATE PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-9280
Practice Address - Country:US
Practice Address - Phone:937-449-3957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health