NPIMap

Organization Active NPI

Legacy Human Services, Inc.

  • Adult Care Home Facility
  • Henderson, NC
National Provider Identifier
1790954576
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
MHL-091-060 Issued in NC
Legal business name
LEGACY HUMAN SERVICES, INC.
Practice address
1642 Graham Ave
Graham Avenue Group Home
Henderson, NC 27536-2914
Phone
(252) 492-9545
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Jacinta Johnson
Title
Executive Director
Phone
(252) 438-6700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Adult Care Home Facility 311ZA0620X MHL-091-060 NC Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X MHL-091-060 NC

Addresses

Primary practice location

1642 Graham Ave
Graham Avenue Group Home
Henderson, NC 27536-2914

Mailing address

PO Box 88
Henderson, NC 27536-0088
Phone (252) 438-6700

Other identifiers 1

IdentifierTypeStateIssuer
7805491MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Legacy Human Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1642 Graham Ave
Henderson, NC 27536
Phone (252) 492-9545

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1790954576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275360088",
            "telephone_number": "252-438-6700",
            "fax_number": "252-438-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 GRAHAM AVE",
            "address_2": "GRAHAM AVENUE GROUP HOME",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362914",
            "telephone_number": "252-492-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HUMAN SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JACINTA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "252-438-6700"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "MHL-091-060",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-091-060",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805491",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.