Provider Demographics
NPI:1891099826
Name:LEGENDS GOLDEN COMMUNITY CORP.
Entity Type:Organization
Organization Name:LEGENDS GOLDEN COMMUNITY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-502-0225
Mailing Address - Street 1:273 CALLE SIERRA MORENA STE 502
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5539
Mailing Address - Country:US
Mailing Address - Phone:787-502-0225
Mailing Address - Fax:787-731-1401
Practice Address - Street 1:STREET NO. 1 RIO PIEDRAS A CAGUAS KM 26 HC 9
Practice Address - Street 2:CAMINO LOS LOPEZ BO. QUEBRADA ARENAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-502-0225
Practice Address - Fax:787-731-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR161310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility