=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629951587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGENDS OF SARASOTA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 UNIVERSITY PKWY
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34243-5832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-259-8971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 HAZELTINE BOULEVARD BOX 36
-----------------------------------------------------
City | CHASKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-361-8000
-----------------------------------------------------
Fax | 952-361-8010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | CLINTON KNACKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-361-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------