Provider Demographics
NPI:1326914730
Name:TKLEGACY
Entity type:Organization
Organization Name:TKLEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-475-4163
Mailing Address - Street 1:965 GROVE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-5943
Mailing Address - Country:US
Mailing Address - Phone:937-475-4163
Mailing Address - Fax:
Practice Address - Street 1:965 GROVE HILL DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-5943
Practice Address - Country:US
Practice Address - Phone:937-475-4163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care