Provider Demographics
NPI:1861795254
Name:LEGACY HOME HEALTHCARE OF SOUTHERN ARIZONA
Entity type:Organization
Organization Name:LEGACY HOME HEALTHCARE OF SOUTHERN ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:520-335-6118
Mailing Address - Street 1:1700 S HWY 92 STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5836
Mailing Address - Country:US
Mailing Address - Phone:520-335-6118
Mailing Address - Fax:520-335-6736
Practice Address - Street 1:1700 S HWY 92 STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5836
Practice Address - Country:US
Practice Address - Phone:520-335-6118
Practice Address - Fax:520-335-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care