NPIMap

Organization Active NPI

Legacy Healthcare Inc.

  • Community Based Hospice Care Agency
  • Albuquerque, NM
National Provider Identifier
1881024826
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LEGACY HEALTHCARE INC.
Practice address
3610 Bosque PLZ NW
Albuquerque, NM 87120-4295
Phone
(505) 338-3702
Fax
(505) 338-3709
NPI assigned
Nov 12, 2013
Last updated
Jan 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Mr. Jimmy Melton
Title
President
Phone
(505) 338-3702

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

3610 Bosque PLZ NW
Albuquerque, NM 87120-4295

Mailing address

3610 Bosque PLZ NW
Albuquerque, NM 87120-4295
Phone (505) 338-3702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140605000579 NM Part A Provider - Hospice 0042343477 Practice locations: Albuquerque, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881024826. Details of each certification follow.

Hospice certification: CCN 321569

Legal name
LEGACY HEALTHCARE, INC
Doing business as
LEGACY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 17, 2014
Last certification
Mar 6, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 29, 2010 in NM
Enrollment address
3610 Bosque Plaza LN NW
Albuquerque, NM 87120-4295

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Legacy HospiceCCN 321569 · All quality measures
Ownership
For-Profit
Certified
Jul 17, 2014
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Legacy Healthcare Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ramona Melton Individual 5% Or Greater Direct Ownership Interest Jul 1, 2015 50%
W-2 Managing EmployeeAdministrator Jul 1, 2015 50%
Jimmy D Melton Individual 5% Or Greater Direct Ownership Interest Jul 1, 2015 50%
W-2 Managing EmployeeChief Executive Officer Jul 1, 2015 50%

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1881024826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 BOSQUE PLZ NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204295",
            "telephone_number": "505-338-3702",
            "fax_number": "505-338-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 BOSQUE PLZ NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871204295",
            "telephone_number": "505-338-3702",
            "fax_number": "505-338-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-338-3702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.