Provider Demographics
NPI:1134766009
Name:AMISI, LEGRAND
Entity type:Individual
Prefix:
First Name:LEGRAND
Middle Name:
Last Name:AMISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2521
Mailing Address - Country:US
Mailing Address - Phone:207-210-9781
Mailing Address - Fax:
Practice Address - Street 1:15 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2521
Practice Address - Country:US
Practice Address - Phone:207-210-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility