Healthcare Provider Details

I. General information

NPI: 1215512306
Provider Name (Legal Business Name): LEGACY ASSISTED CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SAINT ELIZABETH DR
SAN JOSE CA
95126-4322
US

IV. Provider business mailing address

PO BOX 54282
SAN JOSE CA
95154-0282
US

V. Phone/Fax

Practice location:
  • Phone: 408-679-2700
  • Fax: 408-512-1731
Mailing address:
  • Phone: 408-679-2700
  • Fax: 408-512-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS J CONNORS
Title or Position: CEO
Credential: RN
Phone: 408-679-2700