Provider Demographics
NPI:1083466106
Name:LEGACY SENIOR LIVING 2 LLC
Entity Type:Organization
Organization Name:LEGACY SENIOR LIVING 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THI NHU MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-249-0176
Mailing Address - Street 1:19142 STINGRAY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2422
Mailing Address - Country:US
Mailing Address - Phone:714-249-0176
Mailing Address - Fax:
Practice Address - Street 1:19142 STINGRAY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2422
Practice Address - Country:US
Practice Address - Phone:714-249-0176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility