# LEGACY HUMAN SERVICES, INC.

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

## Provider details

- **NPI number:** 1790954576
- **Authorized official:** JACINTA JOHNSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (252) 438-6700

## Contact information

- **Practice address:** 1642 GRAHAM AVE, GRAHAM AVENUE GROUP HOME, HENDERSON, NC 27536-2914
- **Practice address phone:** (252) 492-9545
- **Mailing address:** PO BOX 88, HENDERSON, NC 27536-0088
- **Mailing address phone:** (252) 438-6700
- **Mailing address fax:** (252) 438-6720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | MHL-091-060 | NC | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | MHL-091-060 | NC | — |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 09/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805491 | — | NC |