Provider Demographics
NPI:1255934964
Name:VENERABLE LEGACY LLC
Entity type:Organization
Organization Name:VENERABLE LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-268-3998
Mailing Address - Street 1:2939 CROCKETT ST APT 309S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2955
Mailing Address - Country:US
Mailing Address - Phone:682-268-3998
Mailing Address - Fax:
Practice Address - Street 1:2939 CROCKETT ST APT 309S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2955
Practice Address - Country:US
Practice Address - Phone:682-268-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health