Legacy Lodge at Jackson Hole, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LEGACY LODGE AT JACKSON HOLE, INC.

Practice address

3000 W Big Trail Dr
Jackson, WY 83001-9138

Phone

(307) 734-0500

NPI assigned

Jan 4, 2017

Organization subpart

No

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

Authorized official

Name

Jason Harnisch

Title

VP of Finance

Phone

(402) 753-6101

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1760927453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N SOMERS AVE",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 W BIG TRAIL DR",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830019138",
            "telephone_number": "307-734-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY LODGE AT JACKSON HOLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "HARNISCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "402-753-6101"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa E Larson Hoyt, APRN-BC
• Jamie R Lasden
• Laura Simmons PT LLC
• Hillary Lavino, PCSW
• Cassandra Michelle Lawless, OTR
• Lauren Bayer Leoni
• Sandra Theresa Lerch, C FNP CNM
• Andrea L Lewis, PT
• James Christopher Lewis, PHARMD
• Joy Lewis, MD

• Assisted Living Facility in Jackson, WY
• Providers in Jackson, WY by specialty
• Assisted Living Facility in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.