MEDICARE: LEGACY OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1962335513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY OPCO LLC

Provider Business Mailing Address
First Line	:	175 ROUTE 70 STE 208
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-0954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 N 50TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72904-4451
Country	:	US
Telephone Number	:	732-330-2157
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE MANAGEMENT
Name	:	ESTI PRUZANSKY
Credential	:
Telephone Number	:	732-330-2157

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “LEGACY OPCO LLC ” Practice Location

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