Basic Information
Provider Information | |||||||||
NPI: | 1891859609 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LEGUM HOME HEALTH CARE, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOME IV CARE AND NUTRITIONAL SERVICE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 30 EBCO CIR | ||||||||
Address2: | SUITE 102 | ||||||||
City: | WAYNESBORO | ||||||||
State: | VA | ||||||||
PostalCode: | 229807344 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5409323000 | ||||||||
FaxNumber: | 5409323028 | ||||||||
Practice Location | |||||||||
Address1: | 30 EBCO CIR | ||||||||
Address2: | SUITE 102 | ||||||||
City: | WAYNESBORO | ||||||||
State: | VA | ||||||||
PostalCode: | 229807344 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5409323000 | ||||||||
FaxNumber: | 5409323028 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/19/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DEDRICK | ||||||||
AuthorizedOfficialFirstName: | GREG | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
AuthorizedOfficialTelephone: | 5409323000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
No ID Information.