Provider Demographics
NPI:1134437387
Name:LEGACY HOME CARE, LLC
Entity type:Organization
Organization Name:LEGACY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:423-631-0075
Mailing Address - Street 1:207 E MAIN ST
Mailing Address - Street 2:SUITE 2-J
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5747
Mailing Address - Country:US
Mailing Address - Phone:423-631-0075
Mailing Address - Fax:423-631-0079
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:SUITE 2-J
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5747
Practice Address - Country:US
Practice Address - Phone:423-631-0075
Practice Address - Fax:423-631-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000007123253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4259471OtherBLUE CARE
TNA3760400OtherAMERICHOICE