Legacy Afh LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

LEGACY AFH LLC

Practice address

17702 NE 31St St
Vancouver, WA 98682-3694

Phone

(660) 619-1055

NPI assigned

Mar 26, 2021

Organization subpart

No

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

Authorized official

Name

Timofey Shevchenko, RNNPI 1902483217

Title

Owner

Phone

(660) 619-1055

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Timofey Shevchenko, RN

  • Registered Nurse
  • Vancouver, WA
  • NPI 1902483217
  NPD Authorized official

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616716800000",
    "number": "1538746490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17702 NE 31ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823694",
            "telephone_number": "660-619-1055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17702 NE 31ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823694",
            "telephone_number": "660-619-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY AFH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-26",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "SHEVCHENKO",
        "authorized_official_first_name": "TIMOFEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-619-1055",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902483217",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Leechawengwongs, M.D.
• Mitzy Danae Leeper, LMT, TTT
• Temple Leffingwell
• Michael Scott Lefore, ATC, CSCS
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• Legacy Salmon Creek Hospital
• Legacy Salmon Creek Hospital (Apothecary at Salmon Creek)

• Adult Care Home Facility in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; 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.