Legacy Healthcare Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

116849 Issued in TX

Legal business name

LEGACY HEALTHCARE CORPORATION

Doing business as

Riverwood Healthcare and Rehabilitation

Practice address

600 Bacon St
Madisonville, TX 77864-2511

Phone

(936) 348-9097

Fax

(936) 348-9212

NPI assigned

Jan 22, 2007

Last updated

Jul 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas K Mittleider

Title

President of Management Company

Phone

(770) 619-0866

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Riverwood Healthcare and Rehabilitation Doing business as

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1780737692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BACON ST",
            "city": "MADISONVILLE",
            "state": "TX",
            "postal_code": "778642511",
            "telephone_number": "936-348-9097",
            "fax_number": "936-348-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BACON ST",
            "city": "MADISONVILLE",
            "state": "TX",
            "postal_code": "778642511",
            "telephone_number": "936-348-9097",
            "fax_number": "936-348-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "MITTLEIDER",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT OF MANAGEMENT COMPANY",
        "authorized_official_telephone_number": "770-619-0866"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "116849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5342",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverwood Healthcare and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kinsey Johnson
• Julie Blair Jones, PA-C
• Michael Freeman Lee, LPC
• Virgil Allen Lee, H.I.S.
• Legacy Healthcare Corp
• Donald G Little, MD
• Mac L Bennett III DDS Inc
• Madison St Joseph Health Center (CHI St Joseph Health Madison Hospital)
• Madison St Joseph Health Center (CHI St Joseph Health Madison Hospital)
• Madisonville Cisd

• Skilled Nursing Facility in Madisonville, TX
• Providers in Madisonville, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.