NPIMap

Organization Active NPI

Legacy Hospice LLC

Doing business as Legacy Hospice

  • Community Based Hospice Care Agency
  • Kennett, MO
National Provider Identifier
1033238233
Registry record updated Oct 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LEGACY HOSPICE LLC
Doing business as
Legacy Hospice
Legacy Hospice, Inc.
Practice address
203 1St St Ste a
Kennett, MO 63857-2052
Phone
(573) 888-4946
Fax
(573) 888-4040
NPI assigned
Mar 28, 2007
Last updated
Oct 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Clark Blair, PHD
Title
Ceo
Phone
(205) 652-6167

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

203 1St St Ste a
Kennett, MO 63857-2052

Mailing address

PO Box 2130
Daphne, AL 36526-2130
Phone (205) 652-6167

Other practice location 1

3660 Highway 67 North
Poplar Bluff, MO 63901-6390
Phone (573) 776-6944

Other practice location 2

1435 North Mount Auburn Rd
Suite 201
Cape Girardeau, MO 63701-2590
Phone (573) 803-3862

Other identifiers 1

IdentifierTypeStateIssuer
826132102MedicaidMO

Other names 2

  • Legacy Hospice Doing business as
  • Legacy Hospice, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031003000031 MO Part A Provider - Hospice 7416869441 Practice locations: Poplar Bluff, MO; Cape Girardeau, MO; Kennett, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033238233. Details of each certification follow.

Hospice certification: CCN 261598

Legal name
LEGACY HOSPICE, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 17, 2004
Last certification
Feb 6, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Nov 12, 2019 in MO
Enrollment address
203 1St St
Ste a
Kennett, MO 63857-2052

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Legacy Hospice, LLCCCN 261598 · All quality measures
Ownership
For-Profit
Certified
Mar 17, 2004
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1032397Legacy Hospice, LLC203 1St St Suite a, Kennett, MO 63857Certificate of waiverOct 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Legacy Hospice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

901 W Keiser Ave
Osceola, AR 72370
Phone (870) 563-9995

925 W Keiser Ave
Osceola, AR 72370
Phone (870) 563-9995

1435 N Mount Auburn Rd
Ste 201
Cape Girardeau, MO 63701
Phone (573) 803-3862

203 1st St
Ste A
Kennett, MO 63857
Phone (573) 888-4946

607 Billington St
#B
Kennett, MO 63857

3660 Highway 67 N
Poplar Bluff, MO 63901
Phone (573) 776-6944

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
James G Corbin Individual W-2 Managing EmployeeCoo Oct 1, 2022
Operational/Managerial ControlCoo Oct 1, 2022
Clay Jones Individual W-2 Managing EmployeeChief People Officer Jun 20, 2023
Operational/Managerial ControlChief People Officer Jun 20, 2023
Bain Capital Double Impact Fund III, L.P. Organization, Boston, MA Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 76.82%
Bcdi Legacy Holdings, LP Organization, Boston, MA Created for acquisition, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 100%
LH Holding Company LLC Organization, Daphne, AL Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2019 100%
Bcip Double Impact II, LP Organization, Boston, MA Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 6.27%
Elisha Wilcutt Individual W-2 Managing EmployeeAd; Apr 1, 2024
Andrew P Lofaso Individual W-2 Managing EmployeeVP of Finance, Controller Jun 20, 2023
Operational/Managerial ControlVP of Finance, Controller Jun 20, 2023
Lewis Clark Blair Individual Corporate OfficerCeo Dec 3, 2019
Corporate DirectorCeo Dec 3, 2019
W-2 Managing EmployeeCeo Dec 3, 2019
Katie N Sanders Individual W-2 Managing EmployeeDirector of Systems and Control Oct 1, 2022
Operational/Managerial ControlDirector of Systems and Control Jun 20, 2023
Bcdi Legacy Midco, LLC Organization, Boston, MA Created for acquisition, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 100%
Bcdi Legacy Investor, LP Organization, Boston, MA Created for acquisition, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 96.71%
Bcdi Legacy Topco, LLC Organization, Boston, MA Created for acquisition, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 10, 2025 100%
Legacy Operating Company LLC Organization, Daphne, AL Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2019 100%
Omar Mohammad Khan Individual Contracted Managing EmployeeMD; Jul 1, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Safe Harbor Hospice, LLC

    dba Legacy Hospice

    • Community Based Hospice Care Agency
    • Fredericktown, MO
    • NPI 1215084876

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Homecare Hospice North, LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • New Albany, MS
    • NPI 1164893343

    Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Homecare Hospice South, LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Hattiesburg, MS
    • NPI 1518219773

    Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Homecare Hospice, LLC
    • Community Based Hospice Care Agency
    • Jackson, MS
    • NPI 1326118522

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Legacy Hospice of the East, LLC
    • Community Based Hospice Care Agency
    • Demopolis, AL
    • NPI 1104860428

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Legacy Hospice, LLC

    dba Legacy Hospice

    • Community Based Hospice Care Agency
    • Osceola, AR
    • NPI 1033238241

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Mercy Hospice LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Ripley, MS
    • NPI 1386689016

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Mercy Hospice LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Grenada, MS
    • NPI 1518256460

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Mercy Hospice LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Starkville, MS
    • NPI 1902105976

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Mercy Hospice, LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Batesville, MS
    • NPI 1306141387

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Mercy Hospice, LLC

    dba Legacy Hospice of the South

    • Community Based Hospice Care Agency
    • Selmer, TN
    • NPI 1346975471

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership
  • Watch Care, LLC

    dba Legacy Hospice of North Arkansas

    • Community Based Hospice Care Agency
    • Salem, AR
    • NPI 1609995653

    Bain Capital Double Impact Fund III, L.P., Bcdi Legacy Holdings, LP, Bcdi Legacy Investor, LP, Bcdi Legacy Midco, LLC, Bcdi Legacy Topco, LLC, Bcip Double Impact II, LP, Legacy Operating Company LLC, LH Holding Company LLC

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 7

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760227200000",
    "number": "1033238233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2130",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365262130",
            "telephone_number": "205-652-6167",
            "fax_number": "205-742-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 1ST ST STE A",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572052",
            "telephone_number": "573-888-4946",
            "fax_number": "573-888-4040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3660 HIGHWAY 67 NORTH",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639016390",
            "country_code": "US",
            "telephone_number": "573-776-6944",
            "fax_number": "573-776-7123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1435 NORTH MOUNT AUBURN RD",
            "address_2": "SUITE 201",
            "address_purpose": "LOCATION",
            "city": "Cape Girardeau",
            "state": "MO",
            "postal_code": "637012590",
            "country_code": "US",
            "telephone_number": "573-803-3862",
            "fax_number": "573-803-3899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2025-10-12",
        "certification_date": "2025-10-12",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-652-6167",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826132102",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Legacy Hospice, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennett, MO

Sources for this page

Verify at the official NPI Registry.