Organization
LEGENDARY SUPPORT COORDINATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMONE MARLENA BRUCE (ADMINISTRATOR)
(267) 231-9827
Entity
Organization
Contact information
Practice address
5860 MARKET ST APT 1, PHILADELPHIA, PA 19139-3113
(215) 596-5940
Mailing address
5860 MARKET ST APT 1, PHILADELPHIA, PA 19139-3113
(215) 596-5940
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/04/2015
Last updated
06/04/2019
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