Legacy Care Providers Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

347574 Issued in MN

Legal business name

LEGACY CARE PROVIDERS INC

Practice address

116 Schaaf St
Murdock, MN 56271-7995

Phone

(320) 875-4742

Fax

(320) 875-4555

NPI assigned

Jan 25, 2010

Last updated

Jan 25, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Steven William Tammen

Title

Vice President / Biller

Phone

(320) 847-0617

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1264377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1538490974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 80TH AVE NE",
            "city": "CLARA CITY",
            "state": "MN",
            "postal_code": "562221221",
            "telephone_number": "320-841-0617",
            "fax_number": "320-875-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SCHAAF ST",
            "city": "MURDOCK",
            "state": "MN",
            "postal_code": "562717995",
            "telephone_number": "320-875-4742",
            "fax_number": "320-875-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY CARE PROVIDERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-25",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "TAMMEN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "VICE PRESIDENT / BILLER",
        "authorized_official_telephone_number": "320-847-0617",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "347574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTED LIVING CLASS F HOME CARE PROVIDER",
            "identifier": "347574",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.