Provider Demographics
NPI:1891674966
Name:LEGENDARY HEALTH & HUMAN SERVICES
Entity type:Organization
Organization Name:LEGENDARY HEALTH & HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:GALISON
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-485-2276
Mailing Address - Street 1:715 10TH ST NE APT 304
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3470
Mailing Address - Country:US
Mailing Address - Phone:215-485-2276
Mailing Address - Fax:
Practice Address - Street 1:715 10TH ST NE APT 304
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3470
Practice Address - Country:US
Practice Address - Phone:215-485-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No251K00000XAgenciesPublic Health or Welfare
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty