Provider Demographics
NPI:1952417214
Name:LEGACY HEALTH CARE INC
Entity Type:Organization
Organization Name:LEGACY HEALTH CARE INC
Other - Org Name:LEGACY HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-771-9099
Mailing Address - Street 1:3135 N FAIRFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8832
Mailing Address - Country:US
Mailing Address - Phone:801-771-9099
Mailing Address - Fax:
Practice Address - Street 1:880 HERITAGE PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5680
Practice Address - Country:US
Practice Address - Phone:801-771-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467232Medicare Oscar/Certification