Legacy Healthcare, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LEGACY HEALTHCARE, LLC

Practice address

1070 A St Ste 5
Hayward, CA 94541-4106

Phone

(510) 952-9906

Fax

(510) 952-9927

NPI assigned

Feb 3, 2021

Organization subpart

No

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

Authorized official

Name

John D Williams

Title

Administrator

Phone

(408) 309-5661

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B41628

Legal name

LEGACY HEALTHCARE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 31, 2022

Last certification

May 31, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Jan 6, 2021 in CA

Enrollment address

1070 A St
Ste 5
Hayward, CA 94541-4106

Listed as

Legacy Healthcare, LLCCCN B41628

Certified

May 31, 2022

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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.

Affiliated clinicians 1

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

• Estelita Limbo Carandang, M.D.

  • Internal Medicine Physician
  • San Jose, CA
  • NPI 1255473757

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1326630104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 A ST STE 5",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414106",
            "telephone_number": "510-952-9906",
            "fax_number": "510-952-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 A ST STE 5",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414106",
            "telephone_number": "510-952-9906",
            "fax_number": "510-952-9927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "408-309-5661"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Lee, PHARMD
• Tiffany Lee
• Yuen Yun Lee, NP
• Donna Lefao
• Devette Leflore, RN, PHN CASE MANAGER
• Raquel Ruby Legaspi Reyes
• Lei Lei
• Ashlee Rose Leite
• Marissa Lelina
• Olga Lemberg, MD

• Community Based Hospice Care Agency in Hayward, CA
• Providers in Hayward, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.