Provider Demographics
NPI:1174110019
Name:LEGACY PRIVATE CARE OF TALLAHASSEE, LLC
Entity type:Organization
Organization Name:LEGACY PRIVATE CARE OF TALLAHASSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHART-HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-339-0575
Mailing Address - Street 1:2629 OLD BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3775
Mailing Address - Country:US
Mailing Address - Phone:850-339-0575
Mailing Address - Fax:
Practice Address - Street 1:2629 OLD BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3775
Practice Address - Country:US
Practice Address - Phone:185-033-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health