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LEGACY HEALTHCARE ADVANTAGE LLC NPI 1568974863


NPI Information

NPI: 1568974863
Provider Name: LEGACY HEALTHCARE ADVANTAGE LLC
Classification: In Home Supportive Care - 253Z00000X
Entity Type: Organization

CLIA Number: 42D2237546

Address:
371 E HENRY ST
SPARTANBURG, SC
ZIP 29302
Phone: (864) 431-4273
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LEGACY HEALTHCARE ADVANTAGE LLC is an in home supportive care in Spartanburg, SC. The provider is an In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves. LEGACY HEALTHCARE ADVANTAGE LLC NPI is 1568974863. The provider is registered as an organization entity type.

The provider's business location address is:

371 E HENRY ST
SPARTANBURG, SC
ZIP 29302-607
Phone: (864) 431-4273

The provider's authorized official is Cortella Wilkes .
The authorized official title is Owner and has the following contact phone number (864) 308-8712.

The CLIA number assigned to this NPI record is 42D2237546 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/26/2017 and was last updated on 8/16/2022.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251B00000XCase ManagementNo
2251E00000XHome HealthNo
3251G00000XHospice Care, Community BasedNo
4251J00000XNursing CareNo
5251S00000XCommunity/Behavioral HealthNo
6291U00000XClinical Medical LaboratoryNo
7302R00000XHealth Maintenance OrganizationNo
8320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
9385H00000XRespite CareNo
10385HR2055XRespite CareRespite Care, Mental Illness, ChildNo
11385HR2060XRespite CareRespite Care, Intellectual and/or Developmental DisabilitiesNo
12385HR2065XRespite CareRespite Care, Physical Disabilities, ChildNo
13253Z00000XIn Home Supportive CareYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1EN1733MEDICAIDSOUTH 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: 4/28/2024

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