Provider Demographics
NPI:1700998143
Name:LEGACY HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:LEGACY HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-492-8699
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-0088
Mailing Address - Country:US
Mailing Address - Phone:252-492-8699
Mailing Address - Fax:252-492-1172
Practice Address - Street 1:560 DABNEY DR
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3946
Practice Address - Country:US
Practice Address - Phone:252-738-0002
Practice Address - Fax:252-430-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300213BMedicaid
NC6003181Medicaid
NC8300213Medicaid
NC8300213AMedicaid
NC8300213Medicaid