Provider Demographics
NPI:1942174735
Name:KJC LEGACY LLC
Entity type:Organization
Organization Name:KJC LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MERRIE
Authorized Official - Last Name:MEISER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LNHA-HSE
Authorized Official - Phone:330-599-7316
Mailing Address - Street 1:3515 MANCHESTER RD STE F
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1466
Mailing Address - Country:US
Mailing Address - Phone:330-599-7316
Mailing Address - Fax:330-599-7318
Practice Address - Street 1:3515 MANCHESTER RD STE F
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-1466
Practice Address - Country:US
Practice Address - Phone:330-599-7316
Practice Address - Fax:330-599-7318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KJC LEGACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty