Provider Demographics
NPI:1841021391
Name:LEGACY PLACE SENIOR LIVING COMMUNITY
Entity type:Organization
Organization Name:LEGACY PLACE SENIOR LIVING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAKRESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-710-2255
Mailing Address - Street 1:42816 KEYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3416
Mailing Address - Country:US
Mailing Address - Phone:248-710-2255
Mailing Address - Fax:
Practice Address - Street 1:42816 KEYSTONE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3416
Practice Address - Country:US
Practice Address - Phone:248-710-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based