| Legacy Human Services, Inc. | |
|
630 S Garnett St Henderson NC 27536-4509 | |
| (252) 492-8699 | |
| (252) 492-1172 |
| Full Name | Legacy Human Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 630 S Garnett St, Henderson, North Carolina |
| Authorized Official Name and Position | Lynn Fleming (FINANCE DIRECTOR) |
| Authorized Official Contact | 2524928699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Human Services, Inc. Po Box 88 Henderson NC 27536-0088 Ph: () - | Legacy Human Services, Inc. 630 S Garnett St Henderson NC 27536-4509 Ph: (252) 492-8699 |
| NPI Number | 1881723096 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 09/10/2021 |
| Certification Date | 09/10/2021 |
| Medicare PECOS PAC ID | 3375595366 |
|---|---|
| Medicare Enrollment ID | O20050217000870 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881723096 | NPI | - | NPPES |
| 5900366 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 200100176 (North Carolina) | Primary |
| Provider Name | Charles T Browning |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568672905 PECOS PAC ID: 6305732702 Enrollment ID: I20040224000205 |
| Provider Name | Benjamin Mastridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942421508 PECOS PAC ID: 2860649068 Enrollment ID: I20120823000070 |
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