Basic Information
| Provider Information | |||||||||
| NPI: | 1861483687 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEGUM HOME HEALTH CARE INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOME IV CARE AND NUTRITIONAL SERVICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 30 EBCO CIR | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229807344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409323000 | ||||||||
| FaxNumber: | 5409323018 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 EBCO CIR | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229807344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409323000 | ||||||||
| FaxNumber: | 5409323018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRYSON | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | HALE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIV PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3013530300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 0201002399 | VA | N | Suppliers | Pharmacy | 3336H0001X | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 0201002399 | 01 | VA | BOARD OF PHARMACY | OTHER |