Provider Demographics
NPI:1326405515
Name:LEGACY HEALTH CARE
Entity Type:Organization
Organization Name:LEGACY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPLAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-303-0644
Mailing Address - Street 1:703 FAIRLBUFF DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:910-303-0644
Mailing Address - Fax:
Practice Address - Street 1:703 FAIRBLUFF DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-5673
Practice Address - Country:US
Practice Address - Phone:910-303-0644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility