Provider Demographics
NPI:1841808284
Name:LEGENDARY HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:LEGENDARY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-971-2035
Mailing Address - Street 1:231 HAMPTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2299
Mailing Address - Country:US
Mailing Address - Phone:864-377-8048
Mailing Address - Fax:864-377-8055
Practice Address - Street 1:231 HAMPTON AVE STE D
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2299
Practice Address - Country:US
Practice Address - Phone:864-377-8048
Practice Address - Fax:864-377-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care