Provider Demographics
NPI:1619272499
Name:LEGACY CONNECTIONS
Entity type:Organization
Organization Name:LEGACY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-707-8229
Mailing Address - Street 1:6360 S MINERVA AVE
Mailing Address - Street 2:APT 1012
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3638
Mailing Address - Country:US
Mailing Address - Phone:773-707-8229
Mailing Address - Fax:773-737-4865
Practice Address - Street 1:6360 S MINERVA AVE
Practice Address - Street 2:APT 1012
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3638
Practice Address - Country:US
Practice Address - Phone:773-707-8229
Practice Address - Fax:773-737-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)