Legacy Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LEGACY HOSPICE, LLC

Practice address

4153 Flat Shoals Pkwy Ste 312D
Decatur, GA 30034-4106

Phone

(404) 343-1158

Fax

(404) 343-3972

NPI assigned

Jul 28, 2017

Last updated

Apr 2, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Misty LandorNPI 1518296656

Title

Administrator

Phone

(404) 343-1158

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912421256. Details of each certification follow.

• CCN 851536 Hospice · Active · Details

Hospice certification: CCN 851536

Legal name

LEGACY HOSPICE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 1, 2020

Last certification

Sep 1, 2020

Ownership / control type

Proprietary - Individual

Organization structure

LLCProprietary

Enrollment address

4153 Flat Shoals Pkwy
Building C Suite 312D
Decatur, GA 30034-0983

Listed as

Legacy Hospice, LLCCCN 851536 · All quality measures

Ownership

For-Profit

Certified

Sep 1, 2020

Medicare certification status

ActiveFrom the Provider of Services file

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jean Joseph Philippe-Dambreville, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1639177066

  5% Or Greater Direct Ownership Interest, Contracted Managing Employee

  CMS ownership

Practitioners 2

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.

• Misty Landor, NP-C

  • Adult Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1518296656
  NPD Authorized official
• Jean Joseph Philippe-Dambreville, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1639177066

  Adult Medicine

  NPD (past)

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1912421256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4153 FLAT SHOALS PKWY STE 324A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344106",
            "telephone_number": "404-343-1158",
            "fax_number": "404-343-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4153 FLAT SHOALS PKWY STE 312D",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344106",
            "telephone_number": "404-343-1158",
            "fax_number": "404-343-3972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-28",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "LANDOR",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-343-1158"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vannie Lee III, RRT
• Yejin Lee
• Gayle Leff Goldstein, MD
• Stephen P Leff, MD
• Victoria Leftridge, LPC
• Legacy Living Care
• Legacy Obstetrics and Gynecology
• Charlene Leggett
• Erica Ashley Legons
• Jean Lehmann, MS, RD, LD

• Community Based Hospice Care Agency in Decatur, GA
• Providers in Decatur, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.