Provider Demographics
NPI:1912684127
Name:WEAVER LEGACY ENTERPRISES
Entity Type:Organization
Organization Name:WEAVER LEGACY ENTERPRISES
Other - Org Name:GIFTED COMPANIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-262-5075
Mailing Address - Street 1:1016 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2814
Mailing Address - Country:US
Mailing Address - Phone:254-262-5075
Mailing Address - Fax:
Practice Address - Street 1:800 ELM AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-2658
Practice Address - Country:US
Practice Address - Phone:254-262-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty