Legacy Homecare Associates, LLC
Organization Active NPI Home Health Agency · Pauls Valley, OK
NPI 1730488131 · NPPES record last updated May 20, 2016
Key facts
- NPI
- 1730488131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- LEGACY HOMECARE ASSOCIATES, LLC
- Practice address
- 106 N Cedar St
Pauls Valley, OK 73075-2805 - Phone
- (405) 207-9496
- Fax
- (405) 207-9701
- NPI assigned
- Mar 24, 2011
- Organization subpart
- No
Authorized official
- Name
- Karen E Vahlberg, RN
- Title
- Chief Executive Officer
- Phone
- (405) 329-4545
Facilities with the same owner 37
Affiliated clinicians 13
-
Brian A Allee, D.O.
-
Brett Avery Baldwin, APRN
-
Julia Diaz, APRN
-
D. Bryan Dye, M.D.
-
Jee Hun Jang, DO
-
Stephanie Ranae Mowdy, APRN,MS,CCNS
-
Amanda Rushing-Hiser, CNP
-
Shelly Rae Russeff, APRN-CNP
-
Alisha Jo Whitebird, DNP, APRN, FNP-C
Medicare Care Compare: Home health agency
- Listed as
- Lifespring Home Care
- Overall star rating
- ★★★★☆ 4 of 5
- Ownership
- Proprietary
- Certified
- Mar 30, 2012
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Home health agency certification: CCN 377757
- Legal name
- LEGACY HOMECARE ASSOCIATES, LLC
- Doing business as
- LIFESPRING HOME CARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Mar 30, 2012
- Last certification
- Jan 11, 2021
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 7, 2011 in OK
- Enrollment address
- 106 N Cedar
Pauls Valley, OK 73075
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Julie a Clarkson |
Corporate Officer |
Apr 1, 2024 | |
| Lawana G Nelson |
Corporate Officer |
Apr 1, 2024 | |
| The Deaconess Associations Inc |
5% Or Greater Indirect Ownership Interest | Nov 12, 2021 | 100% |
| Deaconess Healthcare Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Nov 12, 2021 | 100% |
| Lifespring Home Care and Hospice, LLC |
5% Or Greater Direct Ownership Interest | Nov 12, 2021 | 100% |
| Operational/Managerial Control | Jan 1, 2020 | 100% | |
| Meranda Roberts |
Corporate Officer |
Apr 1, 2024 | |
| Erik K Drennen |
Corporate Officer |
Apr 1, 2024 | |
| W-2 Managing Employee |
Apr 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110622000183 | OK | Part a Provider - Home Health Agency | 3577741586 | Practice locations: Pauls Valley, OK |
National Provider Directory
Locations
1416 N Porter Ave
Norman, OK 73071
Phone (405) 928-5533
507 S Willow St
Ste B1
Pauls Valley, OK 73075
Phone (405) 207-9496
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
106 N Cedar St
Pauls Valley, OK 73075-2805
Mailing address
2411 Springer Dr
Norman, OK 73069-3955
Phone (405) 329-4545
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 377757 | Other | OK | MEDICARE PTAN |
Other names
- LifeSpring Home Care
Other providers in Pauls Valley, OK
- Kathryn Elizabeth Kubiak
- Geoffrey Ku Lau
- Mattea Leann Lavin
- Julia Hensley Leadford
- Legacy Drug
- Legacy Pharmacy, LLC
- Cynthia Ann Lemeki
- Era Magdalena Levy
- Lighthouse Behavioral Wellness Centers
- Lighthouse Behavioral Wellness Centers
All providers in Pauls Valley, OK · Home Health Agency in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.