Organization Active NPI

Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Durham, NC
National Provider Identifier
1104823400
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LEGACY HEALTHCARE SERVICES, INC.
Practice address
2701 Pickett Rd
Durham, NC 27705-5688
Phone
(919) 424-5080
Fax
(919) 431-9224
NPI assigned
Jun 30, 2005
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Mr. William Gil Wilson Jr.
Title
Chief Financial Officer
Phone
(919) 424-5080

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

2701 Pickett Rd
Durham, NC 27705-5688

Mailing address

110 Horizon Dr Ste 310
Raleigh, NC 27615-4926
Phone (919) 424-5080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000035 NC Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 2163339722 Practice locations: Raleigh, NC; Greensboro, NC; Morrisville, NC; High Point, NC; Roxboro, NC; Wake Forest, NC; Wilmington, NC; Winston Salem, NC…
O20170118000750 NC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2163339722 Receives reassigned benefits from 306 practitioners

National Provider Directory

National Provider Directory

Locations

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Phone (919) 461-0253

700 N Estes Dr
Chapel Hill, NC 27514
Phone 5122436556737

3701 Taylor GLN LN NW
Concord, NC 28027

5705 Fayetteville Rd
Durham, NC 27713
Phone (919) 401-0100

10810 Sandy Oak Ln
Ste 210
Raleigh, NC 27614

12800 Spruce Tree Way
Apt 210
Raleigh, NC 27614
Phone (919) 438-6889

1500 Sawmill Rd
Apt 382
Raleigh, NC 27615
Phone (919) 870-9322

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Southern Pines, NC 28387
Phone (910) 246-2091

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Phone (864) 841-8341

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Phone (903) 872-2455

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Phone (817) 292-2006

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Phone (254) 651-1010

13800 Bon Secours Dr
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Phone (804) 378-5100

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Windsor Point Inc CCRCFuquay-Varina, NC, CCN 345500 Skilled nursing facility Adp of the SNF Jul 1, 2011

Practitioners & affiliated clinicians

Practitioners 334

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 334

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1104823400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HORIZON DR STE 310",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154926",
            "telephone_number": "919-424-5080",
            "fax_number": "919-431-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 PICKETT RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277055688",
            "telephone_number": "919-424-5080",
            "fax_number": "919-431-9224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GIL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "919-424-5080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.