Legacy 12 Holdings, LLC.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

LEGACY 12 HOLDINGS, LLC.

Practice address

144 Thomas Green Blvd Ste 239
Clemson, SC 29631-2291

Phone

(304) 541-3031

NPI assigned

Dec 10, 2024

Last updated

Dec 10, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

HOME MATTERS CAREGIVINGAs reported in NPPES

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

Authorized official

Name

Tim Dagostine, NA

Title

Owner

Phone

(304) 541-3031

Specialties & licenses 1

Addresses

Part of

Legacy 12 Holdings LLC

Locations

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1073329462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 LONG COVE TRL",
            "city": "SALEM",
            "state": "SC",
            "postal_code": "296763920",
            "telephone_number": "304-541-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 THOMAS GREEN BLVD STE 239",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312291",
            "telephone_number": "304-541-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY 12 HOLDINGS, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOME MATTERS CAREGIVING",
        "enumeration_date": "2024-12-10",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "DAGOSTINE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-541-3031",
        "authorized_official_credential": "NA"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.