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General NPI Number Information
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NPI Number | 1508663907
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Entity Type | Organization
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Legal Business Name | LEGACY LANE SENIOR LIVING
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 7610 LA MANCHA WAY
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City | SACRAMENTO
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State | CA
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Zip | 95823-3837
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Country | US
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Telephone | 564-200-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 FRANKLIN BLVD STE 140
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City | SACRAMENTO
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State | CA
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Zip | 95823-1865
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Country | US
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Telephone | 916-494-9033
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Fax |
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | ALYSSA KERSWELL
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Credential |
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Telephone | 916-494-9033
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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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