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Organization
LEGACY HEALTHCARE ADVANTAGE LLC
Active
Organization
LEGACY HEALTHCARE ADVANTAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORTELLA WILKES (OWNER)
(864) 308-8712
Entity
Organization
Contact information
Practice address
371 E HENRY ST, SPARTANBURG, SC 29302-2607
(864) 431-4273
Mailing address
531 MEADOWSEED CT, LYMAN, SC 29365-1357
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
302R00000X
Health Maintenance Organization
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EN1733
—
SC
Enumeration date
10/26/2017
Last updated
08/16/2022
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