# LEGACY HEALTHCARE SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366063000
- **Authorized official:** WILLIAM G WILSON JR. (CFO)
- **Authorized official phone:** (919) 424-5080

## Contact information

- **Practice address:** 190 RIVER PARK DR, LITTLE RIVER, SC 29566-6844
- **Practice address phone:** (855) 239-3467
- **Mailing address:** 110 HORIZON DR STE 310, RALEIGH, NC 27615-4926
- **Mailing address phone:** (910) 724-7770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 05/05/2020
- **Last updated:** 09/08/2021