NPIMap

Organization Active NPI

Campbell County Hospital District

Doing business as The Legacy Living & Rehabilitation Center

  • Skilled Nursing Facility
  • Gillette, WY
National Provider Identifier
1376620989
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CAMPBELL COUNTY HOSPITAL DISTRICT
Doing business as
The Legacy Living & Rehabilitation Center
Practice address
1000 S Douglas Highway
Gillette, WY 82716
Phone
(307) 688-7000
Fax
(307) 688-7101
NPI assigned
Nov 1, 2006
Last updated
Dec 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CAMPBELL COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Adams
Title
Administrator
Phone
(307) 688-7117

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 07065 WY
Nursing Facility/Intermediate Care Facility 313M00000X 15143 WY
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1000 S Douglas Highway
Gillette, WY 82716

Mailing address

1000 S Douglas Highway
Gillette, WY 82716
Phone (307) 688-7000

Other identifiers 1

IdentifierTypeStateIssuer
119417800MedicaidWY

Other names 1

  • The Legacy Living & Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151026000720 WY Part A Provider - Skilled Nursing Facility 2860392529 Practice locations: Gillette, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376620989. Details of each certification follow.

Skilled nursing facility certification: CCN 535022

Legal name
CAMPBELL COUNTY HOSPITAL DISTRICT
Doing business as
THE LEGACY LIVING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 16, 1984
Last certification
May 23, 2024
Beds
160
Ownership / control type
Hospital District
Organization structure
OtherNon-profit
Incorporated
Jan 1, 1984 in WY
Enrollment address
1000 S Douglas Hwy
Gillette, WY 82716-4908
Nursing home name
THE LEGACY LIVING AND REHABILITATION CENTER

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Legacy Living and Rehabilitation CenterCCN 535022 · All quality measures
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Jun 16, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
16071.5 residents per day on average
Special focus status
SFF
Penalties (3 years)
4Fines totaling $115,597

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D0056366Legacy Living and Rehabilitation Center, the1000 South Douglas Hwy, Gillette, WY 82716Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Wyoming Regional Counseling35 organizations share this tax ID, including this one
Part of
Wyoming Regional Counseling

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alan Stuber Individual Managing Control - Governing BodyDirector Nov 1, 2018
Angela Biggs Individual Managing Control - Governing BodyDirector Nov 22, 2024
Matthew Shahan Individual Corporate OfficerCeo May 16, 2022
Operational/Managerial Control May 16, 2022
Kirtikumar L Patel Individual Operational/Managerial Control Oct 13, 2020
Adp of the SNF Oct 13, 2020
Douglas Adam Popp Individual Corporate OfficerCfo Mar 20, 2023
Operational/Managerial Control Mar 20, 2023
Tom Murphy Individual Managing Control - Governing BodyDirector Nov 1, 2020
Sara L Hartsaw Individual Managing Control - Governing BodyDirector Dec 9, 2022
Randal R Hite Individual Managing Control - Governing BodyDirector Oct 26, 2020
Hollie Alexander Individual Operational/Managerial Control Apr 1, 2025
Adp of the SNF Apr 1, 2025
John L Mansell Individual Managing Control - Governing BodyDirector Oct 29, 2022
John William Rice Individual Managing Control - Governing BodyDirector Oct 29, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Hospice of Campbell County Memorial HospitalGillette, WY, CCN 531519 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 25, 2003

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 61

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1376620989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S DOUGLAS HIGHWAY",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "82716",
            "telephone_number": "307-688-7000",
            "fax_number": "307-688-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S DOUGLAS HIGHWAY",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "82716",
            "telephone_number": "307-688-7000",
            "fax_number": "307-688-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMPBELL COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "307-688-7117"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WY",
            "license": "07065",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WY",
            "license": "15143",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119417800",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Legacy Living & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.