| Legacy Case Management Llc | |
|
5503 West 9000 South Apt B201 West Jordan UT 84081 | |
| (801) 556-4037 | |
| Not Available |
| Full Name | Legacy Case Management Llc |
|---|---|
| Speciality | Case Management |
| Location | 5503 West 9000 South, West Jordan, Utah |
| Authorized Official Name and Position | Tip Bounyasane (PRESIDENT) |
| Authorized Official Contact | 8015564037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Case Management Llc Po Box 632 West Jordan UT 84084-0632 Ph: (801) 556-4037 | Legacy Case Management Llc 5503 West 9000 South Apt B201 West Jordan UT 84081 Ph: (801) 556-4037 |
| NPI Number | 1427942556 |
|---|---|
| Provider Enumeration Date | 06/04/2025 |
| Last Update Date | 06/04/2025 |
| Certification Date | 05/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427942556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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