Provider Demographics
NPI:1215512306
Name:LEGACY ASSISTED CORPORATION
Entity type:Organization
Organization Name:LEGACY ASSISTED CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-679-2700
Mailing Address - Street 1:PO BOX 54282
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95154-0282
Mailing Address - Country:US
Mailing Address - Phone:408-679-2700
Mailing Address - Fax:408-512-1731
Practice Address - Street 1:1050 SAINT ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4322
Practice Address - Country:US
Practice Address - Phone:408-679-2700
Practice Address - Fax:408-512-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care