Organization Name: | LEGACY HEALTHCARE INC. |
NPI Number: | 1881024826 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JIMMY MELTON (PRESIDENT) |
Mailing Address: | 9388 Valley View Dr Nw Suite 300 Albuquerque |
State: | NM US |
Postal Code: | 871144908 |
Phone Number: | 5053383702 |
Fax Number: | 5053383709 |
NPI Enumeration Date: | 11/12/2013 |
NPI Last Update Date: | 06/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |