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General NPI Number Information
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NPI Number | 1104384510
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Entity Type | Organization
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Legal Business Name | LEGACY SKILL NURSING L.L.C.
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 908 CALLE VICTORIA BARIO TEJAS
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-719-7878
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-0246
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Country | US
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Telephone | 787-719-7878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAVIE LOPEZ
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Credential |
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Telephone | 787-607-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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