Organization
LEGACY COMMUNITY HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE CALDWELL (EXEC DIRECTOR)
(832) 548-5051
Entity
Organization
Contact information
Practice address
4610 E CROSSTIMBERS ST, KIPP DREAM PREP ACADEMY, HOUSTON, TX 77016-6337
(713) 636-6082
(713) 523-4897
Mailing address
PO BOX 66308, HOUSTON, TX 77266-6308
(832) 548-5076
(713) 523-4897
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080462703
—
TX
Enumeration date
10/10/2012
Last updated
10/10/2012
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