Provider Demographics
NPI:1285803486
Name:LEGEND HOME HEALTH LLC
Entity type:Organization
Organization Name:LEGEND HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-278-0100
Mailing Address - Street 1:3405 W FULLERTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2415
Mailing Address - Country:US
Mailing Address - Phone:773-278-0100
Mailing Address - Fax:773-278-0111
Practice Address - Street 1:3405 W FULLERTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2415
Practice Address - Country:US
Practice Address - Phone:773-278-0100
Practice Address - Fax:773-278-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health