Legend Home Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

LEGEND HOME CARE LLC

Practice address

3307 Broadway St Ste 150
Mount Vernon, IL 62864-2387

Phone

(618) 731-6550

NPI assigned

Sep 28, 2021

Organization subpart

No

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

Authorized official

Name

Kischa Jackson

Title

Owner/President

Phone

(618) 731-6550

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1801567938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15030 N TUNDRA LN",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628648156",
            "telephone_number": "618-731-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 BROADWAY ST STE 150",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642387",
            "telephone_number": "618-731-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGEND HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KISCHA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "618-731-6550"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Ryan Lane, PA-C
• Kathryn Larko, ATC
• Paula L Lawrence, CRC, LCPC, CADC
• Tedra Ann Lawrence, APRN
• Brian R Lee
• Mike Lehker
• Lisa J Levanti Thomas, LCPC
• Katelyn Marie Lewis, S.T.
• Nicole Marie Lewis, DNP, FNP-BC
• Lifetime Dental Care of Illinois, PC

• All providers in Mount Vernon, IL
• In Home Supportive Care Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.