Provider Demographics
NPI:1124995865
Name:LEGENDARY HEALTHCARE LLC
Entity type:Organization
Organization Name:LEGENDARY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:BRICENO MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-270-1919
Mailing Address - Street 1:3000 N MCCOLL RD STE B8
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1476
Mailing Address - Country:US
Mailing Address - Phone:956-270-1919
Mailing Address - Fax:
Practice Address - Street 1:3000 N MCCOLL RD STE B8
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1476
Practice Address - Country:US
Practice Address - Phone:956-270-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care