Provider Demographics
NPI:1558356949
Name:LEGEND REHABILITATION AND NURSING CENTER INC
Entity Type:Organization
Organization Name:LEGEND REHABILITATION AND NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-632-8776
Mailing Address - Street 1:59 EASTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3901
Mailing Address - Country:US
Mailing Address - Phone:978-632-8776
Mailing Address - Fax:978-632-5048
Practice Address - Street 1:59 EASTWOOD CIR
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3901
Practice Address - Country:US
Practice Address - Phone:978-632-8776
Practice Address - Fax:978-632-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0721314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA805580OtherTUFTS HEALTH
MA0928992Medicaid
MA32655OtherFALLON COMMUNITY HEALTH
MA2222519601OtherBLUE CROSS
MA2222519601OtherBLUE CROSS
MA225196Medicare Oscar/Certification