Provider Demographics
NPI:1033446299
Name:LEGACY HOME HEALTH, INC.
Entity type:Organization
Organization Name:LEGACY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-483-3466
Mailing Address - Street 1:1111 W ROBINHOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5626
Mailing Address - Country:US
Mailing Address - Phone:209-474-0111
Mailing Address - Fax:888-448-8212
Practice Address - Street 1:1111 W ROBINHOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5626
Practice Address - Country:US
Practice Address - Phone:209-474-0111
Practice Address - Fax:888-448-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001148251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health