LEGACY HUMAN SERVICES INC. NPI 1811166507

NPI Information

NPI: 1811166507
Provider Name: LEGACY HUMAN SERVICES, INC.
Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
941 U.S. 158
VANCE ADULT GROUP HOME
HENDERSON, NC
ZIP 27537
Phone: (252) 492-7778
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LEGACY HUMAN SERVICES, INC. is an adult care home custodial care facility in Henderson, NC. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. LEGACY HUMAN SERVICES, INC. NPI is 1811166507. The provider is registered as an organization entity type.

The provider's business location address is:

941 U.S. 158
VANCE ADULT GROUP HOME
HENDERSON, NC
ZIP 27537
Phone: (252) 492-7778
Fax: (252) 438-6720

The provider's authorized official is Jacinta Johnson .
The authorized official title is Executive Director and has the following contact phone number (252) 438-6700.

The enumeration date for this NPI number is 2/27/2008 and was last updated on 9/10/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251S00000X	Community/Behavioral Health				No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		MHL-091-061	NORTH CAROLINA	No
3	311ZA0620X	Custodial Care Facility	Adult Care Home	MHL-091-062	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7805490	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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