# LEGACY HEALTHCARE

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

## Provider details

- **NPI number:** 1376962621
- **Authorized official:** MS. KIM FLORENE FULTZ LPTA (LPTA)
- **Authorized official phone:** (336) 307-6056

## Contact information

- **Practice address:** 3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
- **Practice address phone:** (919) 424-5080
- **Mailing address:** 3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
- **Mailing address phone:** (919) 424-5080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 2870 | NC | Yes |

## Other

- **Enumeration date:** 04/15/2014
- **Last updated:** 04/15/2014