Provider Demographics
NPI:1639529506
Name:LEGASPI MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:LEGASPI MANAGEMENT SERVICES, LLC
Other - Org Name:D' PROVIDENCE CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA BEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:602-332-7290
Mailing Address - Street 1:4523 W HEARN RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4536
Mailing Address - Country:US
Mailing Address - Phone:602-332-7290
Mailing Address - Fax:602-283-5499
Practice Address - Street 1:4523 W HEARN RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4536
Practice Address - Country:US
Practice Address - Phone:602-332-7290
Practice Address - Fax:602-283-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9959H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility