NPIMap

Organization Active NPI

Legacy Health Care, Inc.

  • Community Based Hospice Care Agency
  • Layton, UT
National Provider Identifier
1831196328
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2005-HOSPICE-55836 Issued in UT
Legal business name
LEGACY HEALTH CARE, INC.
Practice address
3135 N Fairfield Rd
Layton, UT 84041-8832
Phone
(801) 771-9099
Fax
(801) 771-0200
NPI assigned
Jun 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Authorized official

Name
Keith G Gordon
Title
Ceo/Administrator
Phone
(801) 771-9099

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2005-HOSPICE-55836 UT Primary

Addresses

Primary practice location

3135 N Fairfield Rd
Layton, UT 84041-8832

Mailing address

3135 N Fairfield Rd
Layton, UT 84041-8832
Phone (801) 771-9099

Other names 1

  • Legacy HealthCare Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000827 UT Part A Provider - Hospice 1254233521 Practice locations: Layton, UT

Hospice certification: CCN 461535

Legal name
LEGACY HEALTH CARE INC
Doing business as
ATLAS HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 16, 2004
Last certification
Dec 22, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 22, 2003 in UT
Enrollment address
880 Heritage Park Blvd
Ste 200
Layton, UT 84041-5680

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Atlas HospiceCCN 461535
Ownership
For-Profit
Certified
Mar 16, 2004
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Atlas Homecare and Hospice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3135 N Fairfield Rd
Layton, UT 84041
Phone (801) 771-9099

880 Heritage Park Blvd
Ste 200
Layton, UT 84041
Phone (801) 771-9099

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Erica Bauer Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Gene R Spaulding Individual 5% Or Greater Direct Ownership InterestTreasurer Aug 1, 2017 28.67%
Corporate Officer Aug 1, 2017
Corporate Director Aug 1, 2017
Nathan S Boswell Individual 5% Or Greater Direct Ownership InterestVice President Aug 1, 2017 28.67%
Corporate Officer Aug 1, 2017
Corporate Director Aug 1, 2017
Patric B Hess Individual 5% Or Greater Direct Ownership InterestSecretary Aug 31, 2017 10%
W-2 Managing Employee Aug 15, 2014
Scott B Monson Individual 5% Or Greater Direct Ownership InterestPresident Aug 1, 2017 28.67%
Corporate Officer Aug 1, 2017
Corporate Director Aug 1, 2017
Casey Lawrence Stelter Individual Contracted Managing EmployeeMedical Director Jan 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 5

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": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1831196328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3135 N FAIRFIELD RD",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418832",
            "telephone_number": "801-771-9099",
            "fax_number": "801-771-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3135 N FAIRFIELD RD",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840418832",
            "telephone_number": "801-771-9099",
            "fax_number": "801-771-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "801-771-9099"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "UT",
            "license": "2005-HOSPICE-55836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy HealthCare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Layton, UT

Sources for this page

Verify at the official NPI Registry.