LEGENDARY SUPPORT COORDINATION, LLC (NPI# 1346693496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346693496 |
| Entity Type | Organization |
| Organization Name | LEGENDARY SUPPORT COORDINATION, LLC |
| Practice Address |
4950 Parkside Ave Ste 102 Philadelphia PA 19131-4700 |
| Practice Telephone | 2155965940 |
| Practice Fax Number | 2159216188 |
| Mailing Telephone | 2155965940 |
| Mailing Fax Number | 2159216188 |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |
| Authorized Official Name | JAMES PETTAWAY (CEO) |
| Authorized Official Telephone | 2155965940 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251G00000X | Hospice Care, Community Based | PA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1030242230001 | 05 | |
| PA | 1030242230002 | 05 |
| Street Address |
4950 PARKSIDE AVE STE 102 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19131-4700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629678925 | Jonathan Welch | Student in an Organized Health Care Education/Training Program | 4200 E City Ave, Rowland Hall, Suite 207, Physician Assistant Department, Philadelphia, PA 19131 | 2020-10-27 |
| 1659970689 | Novacare Outpatient Rehabilitation East, Inc. | Clinic/Center | 1575 North 25nd Street, Philadelphia, PA 19131 | 2020-10-21 |
| 1821629254 | Stephen Osowski | Student in an Organized Health Care Education/Training Program | 4170 City Avenue, Philadelphia, PA 19131 | 2020-02-04 |
| 1134774888 | Arti D Mistry | Dentist | 1126 Horsham Road, Philadelphia, PW 19131 | 2019-08-08 |
| 1275187221 | Grace Bernadette Farrelly | Occupational Therapist | 2101 Simpson House, Philadelphia, PA 19131 | 2019-07-29 |
| 1235795204 | Isd Renal Inc | Clinic/Center | 4952 Parkside Ave, Philadelphia, PA 19131 | 2019-05-15 |
| 1922502582 | Kevin David Wojcik | Student in an Organized Health Care Education/Training Program | Philadelphia College of Osteopathic Medicine, 4190 City Ave, Philadelphia, PA 19131 | 2018-03-20 |
| 1235633900 | Nadja Hill | Home Health | 5203 Diamond Street, Philadelphia, PA 19131 | 2018-03-19 |
| 1932623857 | Mercy Management of Sepa | Social Worker | 1575 N 52nd St Ste 800, Philadelphia, PA 19131 | 2017-08-02 |
| 1578092235 | Sarah Marie Hoder | Specialist/Technologist | 4000 Presidential Avenue, Philadlephia, PA 19131 | 2017-06-07 |
| Find all providers in zip 19131 | ||||
| Taxonomy Code | 251G00000X |
| Grouping | Agencies |
| Classification | Hospice Care, Community Based |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356948731 | Ennoble Care of Pennsylvania LLC | Hospice Care, Community Based | 1650 Market St Ste 2600, Philadelphia, PA 19103-7301 | 2020-10-08 |
| 1013538891 | Vital Alliance Home Care | Hospice Care, Community Based | 3629 Whitehall Ln, Philadelphia, PA 19114-1826 | 2020-05-02 |
| 1912526344 | Philadelphia Family Home Care LLC | Hospice Care, Community Based | 1320 N Franklin St, Philadelphia, PA 19122-4590 | 2020-04-15 |
| 1366071789 | Benevolent Touch Home Healthcare Agency | Hospice Care, Community Based | 6439 Greene St Apt C9, Philadelphia, PA 19119-3236 | 2020-04-07 |
| 1659839470 | Cross Rivers, LLC | Hospice Care, Community Based | 1500 Jfk Blvd Ste 1900, Philadelphia, PA 19102-1714 | 2019-03-11 |
| 1629544283 | Liberty Bell Home Care Services, Inc. | Hospice Care, Community Based | 449 W Dauphin St, Philadelphia, PA 19133-2916 | 2018-10-22 |
| 1386123867 | Aidecare Hospice Inc | Hospice Care, Community Based | 6421 Castor Ave, Philadelphia, PA 19149-2736 | 2018-08-07 |
| 1477047884 | Shanell S Greene | Hospice Care, Community Based | 542 S 54th St, Philadelphia, PA 19143-1916 | 2018-06-19 |
| 1003338823 | Love Begins Home Care LLC | Hospice Care, Community Based | 5636 Pemberton St, Philadelphia, PA 19143-2420 | 2017-07-13 |
| 1780055210 | Dor To Dor Home Care | Hospice Care, Community Based | 6324 Shelbourne St, Philadelphia, PA 19111-5615 | 2015-10-09 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19131 |
Please comment or provide details below to improve the information on LEGENDARY SUPPORT COORDINATION, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.