Organization
LEGEND HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KISCHA JACKSON (OWNER/PRESIDENT)
(618) 731-6550
Entity
Organization
Contact information
Practice address
3307 BROADWAY ST STE 150, MOUNT VERNON, IL 62864-2387
(618) 731-6550
Mailing address
15030 N TUNDRA LN, MOUNT VERNON, IL 62864-8156
(618) 731-6550
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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