Provider Demographics
NPI:1528807427
Name:LEGACY HOME CARE
Entity type:Organization
Organization Name:LEGACY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NJANTOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-441-7639
Mailing Address - Street 1:3909 BLACKBURN LN APT 33
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1239
Mailing Address - Country:US
Mailing Address - Phone:240-441-7639
Mailing Address - Fax:
Practice Address - Street 1:3909 BLACKBURN LN APT 33
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1239
Practice Address - Country:US
Practice Address - Phone:240-441-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services