Provider Demographics
NPI:1396929543
Name:THE LEGACY WILLOW BEND, INC.
Entity type:Organization
Organization Name:THE LEGACY WILLOW BEND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-468-6176
Mailing Address - Street 1:6101 OHIO DR STE 500
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2733
Mailing Address - Country:US
Mailing Address - Phone:972-468-6277
Mailing Address - Fax:972-468-6214
Practice Address - Street 1:6101 OHIO DR STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2733
Practice Address - Country:US
Practice Address - Phone:972-468-6300
Practice Address - Fax:972-468-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
676189Medicare Oscar/Certification