Healthcare Provider Details

I. General information

NPI: 1245543347
Provider Name (Legal Business Name): LEGACY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2010
Last Update Date: 07/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S PINE ST
SEBRING FL
33870-3654
US

IV. Provider business mailing address

725 S PINE ST
SEBRING FL
33870-3654
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-0161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA10655
License Number StateFL

VIII. Authorized Official

Name: MS. JANE H RATHMANNER
Title or Position: COTA/L
Credential:
Phone: 863-382-1971