Provider Demographics
NPI:1730424110
Name:LEGACY COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:LEGACY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-298-1129
Mailing Address - Street 1:8300 HOMESTEAD RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-2145
Mailing Address - Country:US
Mailing Address - Phone:832-298-1129
Mailing Address - Fax:832-230-0272
Practice Address - Street 1:8300 HOMESTEAD RD
Practice Address - Street 2:SUITE #1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2145
Practice Address - Country:US
Practice Address - Phone:832-298-1129
Practice Address - Fax:832-230-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No302R00000XManaged Care OrganizationsHealth Maintenance Organization