Organization
LEGACY FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEEMIA H SHAW LCSW (CEO)
(919) 931-1634
Entity
Organization
Contact information
Practice address
2205 WIDE RIVER DR, RALEIGH, NC 27614-7612
(919) 931-1634
Mailing address
2205 WIDE RIVER DR, RALEIGH, NC 27614-7612
(919) 931-1634
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
C006436
NC
251C00000X
Developmentally Disabled Services Day Training Agency
C006436
NC
251S00000X
Community/Behavioral Health Agency
Primary
C006436
NC
253Z00000X
In Home Supportive Care Agency
COO6436
NC
Other
Enumeration date
01/09/2017
Last updated
01/09/2017
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