Organization
LEGACY HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMY D MELTON (CHIEF EXECUTIVE OFFICER)
(505) 917-7998
Entity
Organization
Contact information
Practice address
3610 BOSQUE PLZ NW, ALBUQUERQUE, NM 87120-4295
(505) 338-3702
(505) 338-3709
Mailing address
3610 BOSQUE PLZ NW, ALBUQUERQUE, NM 87120-4295
(505) 338-3702
(505) 338-3709
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46758810
—
NM
Enumeration date
03/04/2010
Last updated
01/30/2020
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