Healthcare Provider Details

I. General information

NPI: 1992409023
Provider Name (Legal Business Name): LEGACY DUBLIN OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 W DUBLIN GRANVILLE RD
DUBLIN OH
43017-1436
US

IV. Provider business mailing address

12380 PLAZA DR
PARMA OH
44130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 614-210-0541
  • Fax: 614-210-0565
Mailing address:
  • Phone: 216-898-8399
  • Fax: 216-898-8455

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: JIM TAYLOR
Title or Position: CEO
Credential:
Phone: 330-590-0969