1972928208 NPI number — LEGACY HEALTHCARE SERVICES, INC

Table of content: (NPI 1972928208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972928208 NPI number — LEGACY HEALTHCARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY HEALTHCARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEGACY REHABILITATION SERVICES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972928208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 SPRING FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-424-5080
Provider Business Mailing Address Fax Number:
919-431-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 COLLEGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75077-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-420-8543
Provider Business Practice Location Address Fax Number:
972-221-3070
Provider Enumeration Date:
02/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HOSKINS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-424-5081

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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