Provider Demographics
NPI:1386450104
Name:LEGACY CARE COACHES AGENCY
Entity type:Organization
Organization Name:LEGACY CARE COACHES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMARCUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAPTVILLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:225-877-8566
Mailing Address - Street 1:950 MONTERREY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1155
Mailing Address - Country:US
Mailing Address - Phone:225-877-8566
Mailing Address - Fax:
Practice Address - Street 1:1771 LOBDELL BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1767
Practice Address - Country:US
Practice Address - Phone:225-877-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CP WEALTH ALLOCATION RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health