1477067502 NPI number — LEGACY HOME HEALTH CARE

Table of content: (NPI 1477067502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477067502 NPI number — LEGACY HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY HOME HEALTH CARE
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:
Provider Other Organization Name Type Code:
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:
1477067502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7384 STATE ROAD 21 KEYSTONE HEIGHTS, FL 32656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSTONE HEIGHTS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
523-478-7030
Provider Business Mailing Address Fax Number:
352-478-7035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 S LAWRENCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEYSTONE HEIGHTS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32656-9222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-478-7030
Provider Business Practice Location Address Fax Number:
352-478-7035
Provider Enumeration Date:
11/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-478-7030

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299994720 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X , with the licence number: 299994720 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 299994720 . This is a "HOME HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024811500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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