Provider Demographics
NPI:1194430256
Name:LMS LEGACY CARE SERVICES, LLC
Entity type:Organization
Organization Name:LMS LEGACY CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:TISHANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:765-215-3448
Mailing Address - Street 1:3160 CHERRY LAKE LN STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-8613
Mailing Address - Country:US
Mailing Address - Phone:765-215-3448
Mailing Address - Fax:
Practice Address - Street 1:1001 N LELAND AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3338
Practice Address - Country:US
Practice Address - Phone:765-215-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health