Provider Demographics
NPI:1053193334
Name:KJC LEGACY LLC
Entity type:Organization
Organization Name:KJC LEGACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MERRIE
Authorized Official - Last Name:MEISER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LNHA-HSE
Authorized Official - Phone:330-936-7349
Mailing Address - Street 1:3515 MANCHESTER RD STE F
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1466
Mailing Address - Country:US
Mailing Address - Phone:330-599-7316
Mailing Address - Fax:330-599-7318
Practice Address - Street 1:3515 MANCHESTER RD STE F
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-1466
Practice Address - Country:US
Practice Address - Phone:330-599-7316
Practice Address - Fax:330-599-7316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KJC LEGACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based