# LEGACY HUMAN SERVICES, INC.

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

## Provider details

- **NPI number:** 1811166507
- **Authorized official:** JACINTA JOHNSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (252) 438-6700

## Contact information

- **Practice address:** 941 U.S. 158, VANCE ADULT GROUP HOME, HENDERSON, NC 27537
- **Practice address phone:** (252) 492-7778
- **Practice address fax:** (252) 438-6720
- **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-091-062 | NC | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | MHL-091-061 | NC | — |

## Other

- **Enumeration date:** 02/27/2008
- **Last updated:** 09/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805490 | — | NC |