Provider Demographics
NPI:1538788237
Name:LEGACY LIFE SOLUTIONS
Entity type:Organization
Organization Name:LEGACY LIFE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ NEGRETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-523-0769
Mailing Address - Street 1:197 ROUTE 18 STE 3000
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1440
Mailing Address - Country:US
Mailing Address - Phone:732-523-0769
Mailing Address - Fax:
Practice Address - Street 1:197 ROUTE 18 STE 3000
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1440
Practice Address - Country:US
Practice Address - Phone:732-523-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation BrokerGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty