NPIMap

Organization Active NPI

Southwest LTC - Corsicana West LLC

Doing business as Legacy West Rehabilitation and Healthcare

  • Skilled Nursing Facility
  • Corsicana, TX
National Provider Identifier
1730644121
Registry record updated Feb 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SOUTHWEST LTC - CORSICANA WEST LLC
Doing business as
Legacy West Rehabilitation and Healthcare
Practice address
3300 W 2ND Ave
Corsicana, TX 75110-2412
Phone
(903) 874-5333
NPI assigned
Feb 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2019

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

Authorized official

Name
Ronald Payne
Title
Authorized Officer
Phone
(469) 916-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3300 W 2ND Ave
Corsicana, TX 75110-2412

Mailing address

5560 Tennyson Pkwy Ste 210
Plano, TX 75024-3582
Phone (469) 916-6100

Other names 1

  • Legacy West Rehabilitation and Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190510000670 TX Part A Provider - Skilled Nursing Facility 0941543193 Practice locations: Corsicana, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730644121. Details of each certification follow.

Skilled nursing facility certification: CCN 675501

Legal name
SOUTHWEST LTC - CORSICANA WEST LLC
Doing business as
LEGACY WEST REHABILITATION AND HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 16, 1995
Last certification
Nov 21, 2024
Beds
148
Ownership / control type
Corporation
Multi-facility organization
Creative Solutions in Healthcare
Organization structure
LLCProprietary
Enrollment address
3300 W 2ND Ave
Corsicana, TX 75110-2412

Care Compare: Nursing home

Medicare Care Compare
Listed as
Legacy at Corsicana Rehabilitation and HealthcareCCN 675501 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 16, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14857.1 residents per day on average

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
45D1038039Legacy West Rehabilitation & Healthcare3300 W 2ND Ave, Corsicana, TX 75110Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald R Payne Individual 5% Or Greater Indirect Ownership Interest May 1, 2003 73%
Corporate OfficerManager May 1, 2003
Rod Baronet Individual 5% Or Greater Indirect Ownership Interest Jan 30, 2003 5.69%
Ronald R Payne PC Organization, Plano, TX 5% Or Greater Direct Ownership Interest Dec 1, 2004 1%
Barry D Hines Individual 5% Or Greater Indirect Ownership Interest Jan 30, 2003 5.69%
Southwest LTC, LTD Organization, Plano, TX 5% Or Greater Direct Ownership Interest Dec 1, 2004 99%
Quality Care Givers Inc Organization, Plano, TX Corporation 5% Or Greater Indirect Ownership Interest Dec 1, 2004 11.98%
Kristy Keenan Individual W-2 Managing EmployeeAdministrator Apr 1, 2019
Craig H Brashier Individual 5% Or Greater Indirect Ownership InterestMember Dec 1, 2004 9.5%

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

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": "1549756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549756800000",
    "number": "1730644121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5560 TENNYSON PKWY STE 210",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243582",
            "telephone_number": "469-916-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 W 2ND AVE",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751102412",
            "telephone_number": "903-874-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LTC - CORSICANA WEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-10",
        "last_updated": "2019-02-10",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICER",
        "authorized_official_telephone_number": "469-916-6100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy West Rehabilitation and Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corsicana, TX

Sources for this page

Verify at the official NPI Registry.