Healthcare Provider Details

I. General information

NPI: 1215872692
Provider Name (Legal Business Name): LEGACI SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 NELLE PL
FAIR OAKS CA
95628-3940
US

IV. Provider business mailing address

5340 NELLE PL
FAIR OAKS CA
95628-3940
US

V. Phone/Fax

Practice location:
  • Phone: 408-833-8125
  • Fax:
Mailing address:
  • Phone: 408-833-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KARLA NESBITT
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-833-8125