Organization
LEGACY HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA L LANCASTER BSW (PRESIDENT)
(423) 631-0075
Entity
Organization
Contact information
Practice address
207 E MAIN ST, SUITE 2-J, JOHNSON CITY, TN 37604-5747
(423) 631-0075
(423) 631-0079
Mailing address
207 E MAIN ST, SUITE 2-J, JOHNSON CITY, TN 37604-5747
(423) 631-0075
(423) 631-0079
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
L000000007123
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4259471
BLUE CARE
TN
01
—
A3760400
AMERICHOICE
TN
Enumeration date
09/22/2010
Last updated
09/22/2010
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