Legacy Healthcare Corp

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

116849 Issued in TX

Legal business name

LEGACY HEALTHCARE CORP

Practice address

600 Bacon St
Madisonville, TX 77864-2511

Phone

(936) 348-9097

Fax

(936) 348-9212

NPI assigned

Jul 27, 2006

Last updated

Aug 22, 2020By 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

Tom Johnson

Title

Owner

Phone

(423) 478-5953

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831113463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 CENTRAL AVE NE",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373115541",
            "telephone_number": "423-478-5953",
            "fax_number": "423-472-6283"
        },
        {
            "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 CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-478-5953"
    },
    "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": []
}

• Kacelyn Jarrell
• Kinsey Johnson
• Julie Blair Jones, PA-C
• Michael Freeman Lee, LPC
• Virgil Allen Lee, H.I.S.
• Legacy Healthcare Corporation (Riverwood Healthcare and Rehabilitation)
• 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)

• 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 Aug 22, 2020; 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.