Provider Demographics
NPI:1871919654
Name:LEGACY HOME HEALTH & REHABILITATION, LLC
Entity type:Organization
Organization Name:LEGACY HOME HEALTH & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:858-578-3700
Mailing Address - Street 1:9672 VIA EXCELENCIA STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4573
Mailing Address - Country:US
Mailing Address - Phone:858-254-0339
Mailing Address - Fax:858-345-3735
Practice Address - Street 1:9672 VIA EXCELENCIA STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4573
Practice Address - Country:US
Practice Address - Phone:858-578-3700
Practice Address - Fax:858-345-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health