Organization
LEGACY CASE MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIP BOUNYASANE (PRESIDENT)
(801) 556-4037
Entity
Organization
Contact information
Practice address
5503 WEST 9000 SOUTH, APT B201, WEST JORDAN, UT 84081
(801) 556-4037
Mailing address
PO BOX 632, WEST JORDAN, UT 84084-0632
(801) 556-4037
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/04/2025
Last updated
06/04/2025
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