Healthcare Provider Details

I. General information

NPI: 1346414927
Provider Name (Legal Business Name): LTP LEGACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 10TH AVE
OAKLAND CA
94606-3023
US

IV. Provider business mailing address

10 INDIAN WAY
ALAMO CA
94507-2200
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-6512
  • Fax: 510-536-4319
Mailing address:
  • Phone: 925-284-1420
  • Fax: 925-284-3310

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: MRS. LETICIA P PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 925-284-1420