- Enrollment id
- O20250718002088
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548078249
- Multiple npi flag
- N
- Ccn
- 297390
- Associate id
- 9436665205
- Organization name
- LEGACY HOME HEALTH CARE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1500 E TROPICANA AVE
- Address line 2
- STE 124
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891196516