Provider Demographics
NPI:1336446665
Name:LEGACY GENERATION INCORPORATED
Entity Type:Organization
Organization Name:LEGACY GENERATION INCORPORATED
Other - Org Name:MY FAMILY'S HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-764-1819
Mailing Address - Street 1:11012 PARKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4461
Mailing Address - Country:US
Mailing Address - Phone:704-764-1818
Mailing Address - Fax:704-764-1817
Practice Address - Street 1:5960 FAIRVIEW RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3119
Practice Address - Country:US
Practice Address - Phone:704-764-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4364OtherNC DHSR
NC3419019Medicaid