Healthcare Provider Details

I. General information

NPI: 1962335513
Provider Name (Legal Business Name): LEGACY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 N 50TH ST
FORT SMITH AR
72904-4451
US

IV. Provider business mailing address

175 ROUTE 70 STE 208
TOMS RIVER NJ
08755-0954
US

V. Phone/Fax

Practice location:
  • Phone: 732-330-2157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ESTI PRUZANSKY
Title or Position: DIRECTOR OF REVENUE MANAGEMENT
Credential:
Phone: 732-330-2157