Provider Demographics
NPI:1619594991
Name:THE LEGACY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:THE LEGACY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-2045
Mailing Address - Street 1:624 PTARMIGAN LN
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0557
Mailing Address - Country:US
Mailing Address - Phone:406-442-2045
Mailing Address - Fax:406-235-7086
Practice Address - Street 1:624 PTARMIGAN LN
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0557
Practice Address - Country:US
Practice Address - Phone:406-442-2045
Practice Address - Fax:406-235-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility