Legacy Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LEGACY WELLNESS LLC

Practice address

263 S Fork Loop
Stuart, VA 24171-2659

Phone

(276) 790-4649

NPI assigned

Apr 13, 2021

Last updated

Apr 13, 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

Shannon Walker Huffman, QMHP

Title

Ceo

Phone

(276) 790-4649

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1710567763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 S FORK LOOP",
            "city": "STUART",
            "state": "VA",
            "postal_code": "241712659",
            "telephone_number": "276-790-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 S FORK LOOP",
            "city": "STUART",
            "state": "VA",
            "postal_code": "241712659",
            "telephone_number": "276-790-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-13",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "HUFFMAN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "WALKER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "276-790-4649",
        "authorized_official_credential": "QMHP"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@legacywellness.care",
            "affiliation": "N",
            "endpointDescription": "company email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "263 S Fork Loop",
            "city": "Stuart",
            "state": "VA",
            "country_code": "US",
            "postal_code": "241712659",
            "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 Apr 13, 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.