Provider Demographics
NPI:1306284674
Name:LEGACY
Entity type:Organization
Organization Name:LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:828-729-2457
Mailing Address - Street 1:1222 NC HIGHWAY 801 N
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6757
Mailing Address - Country:US
Mailing Address - Phone:828-729-2457
Mailing Address - Fax:
Practice Address - Street 1:903 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055
Practice Address - Country:US
Practice Address - Phone:336-677-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4645313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility