Legacy Healthcare Services

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

2005028265 Issued in MO

Legal business name

LEGACY HEALTHCARE SERVICES

Practice address

15822 Clayton Rd
Ellisville, MO 63011-2212

Phone

(636) 220-1681

Fax

(314) 200-4636

NPI assigned

Jan 8, 2016

Organization subpart

No

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

Authorized official

Name

Kelly Ann Fiala, MOTR/L

Title

OT/Rehab Director

Phone

(636) 448-2881

Specialties & licenses 1

Addresses

Other names 1

• The Fountains of West County Other name

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

CLIA laboratory certificates

Tax ID family

Greenleaf Adult Family Care Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Greenleaf Adult Family Care Home

  • Adult Care Home Facility
  • Cape Coral, FL
  • NPI 1477994499
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roberta Rose, COTA/L

  • Occupational Therapy Assistant
  • Ellisville, MO
  • NPI 1407224645
  NPD (past)
• Susan Diane Trimble, LPTA

  • Physical Therapy Assistant
  • Ellisville, MO
  • NPI 1194490938
  NPD (past)
• Tonya Wilson, PTA

  • Physical Therapy Assistant
  • Ellisville, MO
  • NPI 1790154581
  NPD (past)

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452211200000",
    "number": "1699131573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15822 CLAYTON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112212",
            "telephone_number": "636-220-1681",
            "fax_number": "314-200-4636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15822 CLAYTON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112212",
            "telephone_number": "636-220-1681",
            "fax_number": "314-200-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-01-08",
        "status": "A",
        "authorized_official_last_name": "FIALA",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OT/REHAB DIRECTOR",
        "authorized_official_telephone_number": "636-448-2881",
        "authorized_official_credential": "MOTR/L"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MO",
            "license": "2005028265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Fountains of West County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelly Larkin
• Laura Modica LPC
• Laurie C. Burke, Doctor of Chiropractic P.C.
• Lawler Chiropractic LLC (Total Health Correction Wellness and Chiropractor)
• Sarah Liann Lawler, DC
• Christen Lehmann, PHARM.D.
• David Leonard, DC
• Life Skills Foundation
• Bryan J Lind, PT
• Heather Little

• Clinic/Center in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.