Provider Demographics
NPI:1932435799
Name:LEGACY PLACE TWINSBURG,LLC
Entity Type:Organization
Organization Name:LEGACY PLACE TWINSBURG,LLC
Other - Org Name:LEGACY PLACE TWINSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DASKAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-898-8399
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8399
Mailing Address - Fax:216-898-8455
Practice Address - Street 1:9928 VAIL DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2972
Practice Address - Country:US
Practice Address - Phone:216-898-8399
Practice Address - Fax:216-898-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
OH1002990314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3040042Medicaid
OH3040042Medicaid