Provider Demographics
NPI:1023817988
Name:LEGACY HOME HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:LEGACY HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:386-344-1422
Mailing Address - Street 1:4846 NW LAKE JEFFERY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4797
Mailing Address - Country:US
Mailing Address - Phone:386-344-1422
Mailing Address - Fax:
Practice Address - Street 1:4846 NW LAKE JEFFERY RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4797
Practice Address - Country:US
Practice Address - Phone:386-344-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health