- Enrollment id
- O20120405000534
- Enrollment state
- AL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1104860428
- Multiple npi flag
- N
- Ccn
- 011604
- Associate id
- 7315108057
- Organization name
- LEGACY HOSPICE OF THE EAST, LLC
- Doing business as name
- LEGACY OPERATING COMPANY, LLC
- Incorporation date
- 2011-06-16
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1111 S CEDAR AVE
- Address line 2
- STE D
- City
- DEMOPOLIS
- State
- AL
- Zip code
- 367323309