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General NPI Number Information
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NPI Number | 1477108397
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Entity Type | Organization
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Legal Business Name | THE LEGACY ASSISTED LIVING LLC
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 810 WICKS LN
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City | BILLINGS
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State | MT
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Zip | 59105-4426
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Country | US
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Telephone | 406-252-0042
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Fax | 406-578-1704
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Provider Business Mailing Address
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Address Line | 624 PTARMIGAN LN
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City | HELENA
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State | MT
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Zip | 59602-0557
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Country | US
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Telephone | 406-925-3578
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Fax | 406-235-7086
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Authorized Official
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Title or Position | REGIONAL OPERATIONS DIRECTOR
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Name | MONICA ESTHER MARTINEZ
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Credential |
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Telephone | 406-442-2045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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