Provider Demographics
NPI:1306699822
Name:LEGACY UNITED HOMEHEALTH CARE, LLC
Entity type:Organization
Organization Name:LEGACY UNITED HOMEHEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-993-0645
Mailing Address - Street 1:15516 EXMORE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1491
Mailing Address - Country:US
Mailing Address - Phone:571-993-0645
Mailing Address - Fax:
Practice Address - Street 1:15516 EXMORE CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-1491
Practice Address - Country:US
Practice Address - Phone:571-993-0645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care