Organization
LEGACY HOME HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ONTARIUS BELL (ADMINISTRATOR)
(414) 460-7971
Entity
Organization
Contact information
Practice address
6410 W NORTH AVE, WAUWATOSA, WI 53213-2015
(414) 930-0464
(414) 930-0493
Mailing address
6410 W NORTH AVE, WAUWATOSA, WI 53213-2015
(414) 930-0464
(414) 930-0493
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054125
—
WI
Enumeration date
03/07/2016
Last updated
03/21/2016
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