1568690352 NPI number — LEGACY HOME CARE SERVICES, INC.

Table of content: (NPI 1568690352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568690352 NPI number — LEGACY HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY HOME CARE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALL SEASONS HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568690352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6655 FIRST PARK TEN BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78213-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-584-7444
Provider Business Mailing Address Fax Number:
956-584-8573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 W ALBERTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-9658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-584-7444
Provider Business Practice Location Address Fax Number:
956-584-8573
Provider Enumeration Date:
06/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
AMBROSE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-584-7444

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010852 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3747P1801X , with the licence number: 010852 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)