Provider Demographics
NPI:1215269485
Name:LEGACY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:LEGACY HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:281-513-1564
Mailing Address - Street 1:10135 GLENGATE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8607
Mailing Address - Country:US
Mailing Address - Phone:713-541-3033
Mailing Address - Fax:713-541-8533
Practice Address - Street 1:10135 GLENGATE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8607
Practice Address - Country:US
Practice Address - Phone:713-541-3033
Practice Address - Fax:713-541-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health