Legendary Support Coordination, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LEGENDARY SUPPORT COORDINATION, LLC

Practice address

4950 Parkside Ave Ste 102
Philadelphia, PA 19131-4700

Phone

(215) 596-5940

Fax

(215) 921-6188

NPI assigned

Jul 13, 2016

Organization subpart

No

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

Authorized official

Name

James Pettaway

Title

Ceo

Phone

(215) 596-5940

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Legendary Support Coordination LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Legendary Service Coordination

  • Community Based Hospice Care Agency
  • Philadelphia, PA
  • NPI 1598146615
  NPD tax ID
• Legendary Support Coordination LLC

  • Case Management Agency
  • Philadelphia, PA
  • NPI 1396122909
  NPD tax ID

Locations

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1346693496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 PARKSIDE AVE STE 102",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191314700",
            "telephone_number": "215-596-5940",
            "fax_number": "215-921-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 PARKSIDE AVE STE 102",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191314700",
            "telephone_number": "215-596-5940",
            "fax_number": "215-921-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDARY SUPPORT COORDINATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "PETTAWAY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-596-5940"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030242230001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030242230002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Sayan Legan, MD
• Legendary Cares
• Legendary Homecare LLC
• Legendary Service Coordination
• Legendary Support Coordination LLC
• Alyson June Legensky
• Alana Leger
• Shakira Legett
• Brett Dustin Leggett, MD
• Sakeia Cyrell Leggett

• Community Based Hospice Care Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community Based Hospice Care Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; 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.