Legacy Healthcare, Inc

Key facts

NPI

1013230069

Entity type

Organization (NPI type 2)

Primary specialty

Home Health Agency 251E00000X

Legal business name

LEGACY HEALTHCARE, INC

Practice address

3610 Bosque PLZ NW
Albuquerque, NM 87120-4295

Phone

(505) 338-3702

Fax

(505) 338-3709

NPI assigned

Mar 4, 2010

Organization subpart

No

Authorized official

Name

Mr. Jimmy D Melton

Title

Chief Executive Officer

Phone

(505) 917-7998

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Legacy Healthcare Inc. Community Based Hospice Care Agency · Albuquerque, NM · NPI 1881024826
  Same PAC ID 0042343477

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

• Legacy Healthcare Inc. Community Based Hospice Care Agency · Albuquerque, NM · NPI 1881024826
  NPD tax ID

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Camila S Jaramillo, MD Internal Medicine Physician · Los Ranchos, NM · NPI 1790879187
  Care Compare affiliation Home health agency
• Lindsey Lucero, FNP-C Family Medicine Physician · Edgewood, NM · NPI 1750150272
  Care Compare affiliation Home health agency

Medicare Care Compare: Home health agency

Listed as

Legacy Home Health CCN 327211

Overall star rating

★★★☆☆ 2.5 of 5

Ownership

Proprietary

Certified

Nov 11, 2010

Medicare certification status

Active (Provider of Services file)

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NM

Home health agency certification: CCN 327211

Legal name

LEGACY HEALTHCARE, INC

Doing business as

LEGACY HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 11, 2010

Last certification

Oct 4, 2019

Ownership / control type

Proprietary

Organization structure

Corporation · Proprietary

Incorporated

Dec 15, 2009 in NM

Enrollment address

3610 Bosque Plaza LN NW
Albuquerque, NM 87120-4295

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Medicare enrollment records

National Provider Directory

Tax ID family

Legacy Healthcare Inc (2 organizations share this tax ID)

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 30, 2020.

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1013230069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 BOSQUE PLZ NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204295",
            "telephone_number": "505-338-3702",
            "fax_number": "505-338-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 BOSQUE PLZ NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204295",
            "telephone_number": "505-338-3702",
            "fax_number": "505-338-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-04",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "505-917-7998",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46758810",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Victoria Leftwich
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• Legacy Healthcare Services Inc.
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• Paul Morris Legant, M.D.
• Stephen Mark Legate, D.C.
• Legends Pharmacy III Services LLC

All providers in Albuquerque, NM · Home Health Agency in New Mexico