Legendary Family Care Company LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

LEGENDARY FAMILY CARE COMPANY LLC

Practice address

263 W Bobcat CT
Casa Grande, AZ 85122-1043

Phone

(414) 731-9004

NPI assigned

May 11, 2022

Last updated

May 11, 2022By 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

Melani Sellers

Title

Ceo

Phone

(414) 731-9004

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1528704640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 W BOBCAT CT",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851221043",
            "telephone_number": "414-731-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 W BOBCAT CT",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851221043",
            "telephone_number": "414-731-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDARY FAMILY CARE COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "MELANI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "414-731-9004"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ DEPARTMENT OF HEALTH SERVICES",
            "identifier": "BH7573",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "DRS",
            "affiliation": "N",
            "address_1": "263 W Bobcat Ct",
            "city": "Casa Grande",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "851221043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.