# LEGACY LACE WIGS LLC.

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

## Provider details

- **NPI number:** 1902212855
- **Authorized official:** RYAN SANFORD (COO)
- **Authorized official phone:** (972) 914-9447

## Contact information

- **Practice address:** 2605 SAGEBRUSH DR, SUITE 105, FLOWER MOUND, TX 75028-2761
- **Practice address phone:** (972) 914-9447
- **Mailing address:** 2201 LONG PRAIRIE RD, 107-824, FLOWER MOUND, TX 75022-4832
- **Mailing address phone:** (972) 914-9447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 07/10/2014
- **Last updated:** 07/31/2015