NPIMap

Organization Active NPI

Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Winder, GA
National Provider Identifier
1831619337
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LEGACY HEALTHCARE SERVICES, INC.
Practice address
901 Haymon Morris Rd
Winder, GA 30680-7837
Phone
(678) 705-2123
NPI assigned
Jun 26, 2017
Last updated
Nov 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Authorized official

Name
William G. Wilson Jr.
Title
Cfo
Phone
(919) 424-5080

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

901 Haymon Morris Rd
Winder, GA 30680-7837

Mailing address

110 Horizon Dr Ste 310
Raleigh, NC 27615-4926
Phone (919) 424-5080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170912002360 GA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 2163339722 Practice locations: Alpharetta, GA; Atlanta, GA; Bogart, GA; Johns Creek, GA; Winder, GA; Smyrna, GA
O20220916001457 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2163339722 Receives reassigned benefits from 60 practitioners
Practice locations: Buford, GA; Roswell, GA; Marietta, GA; Johns Creek, GA; Canton, GA; Atlanta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831619337. Details of each certification follow.

  • CCN 116902 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 116902

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LEGACY HEALTHCARE SERVICES, INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 30, 2017
Last certification
Jun 20, 2024
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
901 Haymon Morris Rd
Winder, GA 30680

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Windsor Point Inc CCRCFuquay-Varina, NC, CCN 345500 Skilled nursing facility Adp of the SNF Jul 1, 2011

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1831619337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HORIZON DR STE 310",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154926",
            "telephone_number": "919-424-5080",
            "fax_number": "919-431-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 HAYMON MORRIS RD",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306807837",
            "telephone_number": "678-705-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "919-424-5080",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winder, GA

Sources for this page

Verify at the official NPI Registry.