Provider Demographics
NPI:1427873934
Name:LEGACY LIVING ENTERPRISES, LLC
Entity type:Organization
Organization Name:LEGACY LIVING ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDEROB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-252-0042
Mailing Address - Street 1:810 WICKS LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4426
Mailing Address - Country:US
Mailing Address - Phone:406-270-8580
Mailing Address - Fax:
Practice Address - Street 1:810 WICKS LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4426
Practice Address - Country:US
Practice Address - Phone:406-270-8580
Practice Address - Fax:406-578-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility