Provider Demographics
NPI:1427776814
Name:LEGION MANOR LLC
Entity type:Organization
Organization Name:LEGION MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACANILAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-551-4224
Mailing Address - Street 1:6842 E POSADA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6842 E POSADA CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2944
Practice Address - Country:US
Practice Address - Phone:480-629-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility