Organization
LEGACY HOME CARE LC
Active
Other names
Legacy Home Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER WAYDE SONDRUP PT (OWNER ADMINISTRATOR)
(208) 888-3669
Entity
Organization
Contact information
Practice address
680 S PROGRESS AVE, SUITE 2A, MERIDIAN, ID 83642-2957
(208) 888-3669
(208) 888-3675
Mailing address
680 S PROGRESS AVE, SUITE 2A, MERIDIAN, ID 83642-2957
(208) 888-3669
(208) 888-3675
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HH-224
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806775
—
ID
Enumeration date
01/08/2007
Last updated
08/07/2007
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