# LEGACY CARE ACO LLC

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

## Provider details

- **NPI number:** 1538844857
- **Authorized official:** TRACI LOPEZ (DIRECTOR REVENUE CYCLE)
- **Authorized official phone:** (757) 536-2411

## Contact information

- **Practice address:** 780 LYNNHAVEN PKWY STE 400, VIRGINIA BCH, VA 23452-7332
- **Practice address phone:** (757) 536-2246
- **Mailing address:** PO BOX 830063, PHILADELPHIA, PA 19182-0063
- **Mailing address phone:** (757) 536-2246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/15/2023
- **Last updated:** 03/20/2026