Legacy Healthcare Services Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LEGACY HEALTHCARE SERVICES INC

Practice address

42015 N Venture Dr
Anthem, AZ 85086-3300

Phone

(855) 239-3467

NPI assigned

Jan 31, 2020

Organization subpart

No

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

Addresses

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1962033613",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42015 N VENTURE DR",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850863300",
            "telephone_number": "855-239-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "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": []
}

• Landmark Medical LLC
• George Langford
• Lasting Smiles of Anthem LLC
• Sung Ae Lee, M.D.
• Legacy Behavioral Health,LLC
• Ludmela Lola Leshney, MFT
• Ryan Joseph Levins, PT, DPT
• Ruiwei Liang
• Marcia Lonetti
• Sheena Lyn, DMD

• Physical Therapist in Anthem, AZ
• Providers in Anthem, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.