Provider Demographics
NPI:1922137561
Name:LEGACY ASSISTED LIVING
Entity Type:Organization
Organization Name:LEGACY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADCARE HEALTH SYSTEM VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:695 WYCLIFFE DRIVE
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385
Mailing Address - Country:US
Mailing Address - Phone:937-372-0359
Mailing Address - Fax:937-372-0037
Practice Address - Street 1:695 WYCLIFFE DRIVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385
Practice Address - Country:US
Practice Address - Phone:937-372-0359
Practice Address - Fax:937-372-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility