# LEGACY CARE LLC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Residential Care Home, Legacy Affordable Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073195673
- **Authorized official:** MRS. KIMBERLY ANN LOCKETT ADM (ADMINISTRATOR)
- **Authorized official phone:** (918) 378-9258

## Contact information

- **Practice address:** 9125 S SHERIDAN RD STE 105, TULSA, OK 74133-5330
- **Practice address phone:** (918) 378-9258
- **Mailing address:** 6742 E 91ST PL APT 3, TULSA, OK 74133-5395
- **Mailing address phone:** (918) 378-9258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/22/2021
- **Last updated:** 04/22/2021