Provider Demographics
NPI:1891511721
Name:LEGACY AT HOME LLC
Entity type:Organization
Organization Name:LEGACY AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TENDAYI
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:610-858-7410
Mailing Address - Street 1:302 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9262
Mailing Address - Country:US
Mailing Address - Phone:610-858-7410
Mailing Address - Fax:484-363-5923
Practice Address - Street 1:302 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-9262
Practice Address - Country:US
Practice Address - Phone:610-858-7410
Practice Address - Fax:484-363-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care