Provider Demographics
NPI:1134998453
Name:LEGACY HOMECARE GROUP, LLC
Entity type:Organization
Organization Name:LEGACY HOMECARE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-641-5386
Mailing Address - Street 1:1415 PIEDMONT DR E STE 4
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7944
Mailing Address - Country:US
Mailing Address - Phone:850-641-5383
Mailing Address - Fax:
Practice Address - Street 1:1415 PIEDMONT DR E STE 4
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7944
Practice Address - Country:US
Practice Address - Phone:850-641-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care