Organization
LEGACY HUMAN SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACINTA JOHNSON (EXECUTIVE DIRECTOR)
(252) 438-6700
Entity
Organization
Contact information
Practice address
1642 GRAHAM AVE, GRAHAM AVENUE GROUP HOME, HENDERSON, NC 27536-2914
(252) 492-9545
Mailing address
PO BOX 88, HENDERSON, NC 27536-0088
(252) 438-6700
(252) 438-6720
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
MHL-091-060
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-091-060
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805491
—
NC
Enumeration date
02/26/2008
Last updated
09/10/2021
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