Provider Demographics
NPI:1780426064
Name:ATOMIC LEGACY HOME HEALTH, LLC
Entity type:Organization
Organization Name:ATOMIC LEGACY HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-528-1512
Mailing Address - Street 1:303 BRADLEY BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4497
Mailing Address - Country:US
Mailing Address - Phone:509-728-9594
Mailing Address - Fax:509-728-9535
Practice Address - Street 1:3601 W SAHARA AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5818
Practice Address - Country:US
Practice Address - Phone:509-728-9594
Practice Address - Fax:509-728-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health