Family Legacy Home Health Care

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

FAMILY LEGACY HOME HEALTH CARE

Practice address

12633 Stoneridge Dr
Black Jack, MO 63033-4618

Phone

(314) 651-7172

Fax

(314) 653-0258

NPI assigned

Jul 27, 2021

Last updated

Jul 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Brenda Gail Marshall, AM

Title

Owner Member

Phone

(314) 651-7172

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1114690906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12633 STONERIDGE DR",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630334618",
            "telephone_number": "314-651-7172",
            "fax_number": "314-653-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12633 STONERIDGE DR",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630334618",
            "telephone_number": "314-651-7172",
            "fax_number": "314-653-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LEGACY HOME HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "OWNER MEMBER",
        "authorized_official_telephone_number": "314-651-7172",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AM"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "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 Jul 27, 2021; 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.