Provider Demographics
NPI:1952940041
Name:BLAIR LEGACY, LLC
Entity Type:Organization
Organization Name:BLAIR LEGACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-972-0018
Mailing Address - Street 1:554 N STEELHEAD WAY STE 180
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8388
Mailing Address - Country:US
Mailing Address - Phone:208-515-6522
Mailing Address - Fax:
Practice Address - Street 1:554 N STEELHEAD WAY STE 180
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8388
Practice Address - Country:US
Practice Address - Phone:208-515-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty