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General NPI Number Information
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NPI Number | 1346414927
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Entity Type | Organization
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Legal Business Name | LTP LEGACY, LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 1833 10TH AVE
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City | OAKLAND
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State | CA
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Zip | 94606-3023
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Country | US
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Telephone | 510-536-6512
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Fax | 510-536-4319
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Provider Business Mailing Address
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Address Line | 10 INDIAN WAY
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City | ALAMO
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State | CA
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Zip | 94507-2200
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Country | US
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Telephone | 925-284-1420
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Fax | 925-284-3310
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LETICIA P PEREZ
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Credential |
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Telephone | 925-284-1420
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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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