# ELEGANT LEGACY HOME CARE AND REHAB LLC

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

## Provider details

- **NPI number:** 1750915591
- **Authorized official:** JESSICA LONTAYO OT (OWNER/CEO)
- **Authorized official phone:** (858) 880-8934

## Contact information

- **Practice address:** 12180 RAGWEED ST, SAN DIEGO, CA 92129-4104
- **Practice address phone:** (858) 880-8934
- **Mailing address:** 12180 RAGWEED ST, SAN DIEGO, CA 92129-4104
- **Mailing address phone:** (858) 880-8934

## Taxonomy

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

## Other

- **Enumeration date:** 03/02/2020
- **Last updated:** 03/02/2020