Legacy Community Care Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LEGACY COMMUNITY CARE INC

Practice address

1022 42 1/2 Ave NE
Columbia Heights, MN 55421-3159

Phone

(763) 444-1893

Fax

(763) 331-0644

NPI assigned

Mar 24, 2023

Organization subpart

No

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

Authorized official

Name

Ahmed Yusuf

Title

Owner/Admin

Phone

(612) 806-6357

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1699478040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 42 1/2 AVE NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554213159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 42 1/2 AVE NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554213159",
            "telephone_number": "763-444-1893",
            "fax_number": "763-331-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY COMMUNITY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "YUSUF",
        "authorized_official_first_name": "AHMED",
        "authorized_official_title_or_position": "OWNER/ADMIN",
        "authorized_official_telephone_number": "612-806-6357"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.