Healthcare Provider Details

I. General information

NPI: 1538529540
Provider Name (Legal Business Name): LEGACY HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 NUWAY CIR
LENOIR NC
28645-3656
US

IV. Provider business mailing address

322 NUWAY CIR
LENOIR NC
28645-3656
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10214
License Number StateNC

VIII. Authorized Official

Name: SONJA MEBERG
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 407-697-5300