Legacy

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5022 Issued in NC

Legal business name

LEGACY

Practice address

2275 Ruin Creek Rd
Henderson, NC 27537-8732

Phone

(252) 492-0066

NPI assigned

Jul 5, 2013

Last updated

Jul 5, 2013By 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

Mrs. Jayme Michele Bourgeois, OTA/L

Title

Occupational Therapy Assistant

Phone

(919) 435-1284

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1372982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372982400000",
    "number": "1831539824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 RUIN CREEK ROAD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "27537",
            "telephone_number": "252-492-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275378732",
            "telephone_number": "252-492-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-05",
        "last_updated": "2013-07-05",
        "status": "A",
        "authorized_official_last_name": "BOURGEOIS",
        "authorized_official_first_name": "JAYME",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPY ASSISTANT",
        "authorized_official_telephone_number": "919-435-1284",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTA/L"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "5022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTA/L",
            "identifier": "5022",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chippy Lavache
• Lavni, Inc
• Simone Cherelle Lawrence
• Nathalie V Laytham, PA-C
• Kathleen Lee
• Legacy Human Services, Inc.
• Legacy Human Services, Inc.
• Legacy Human Services, Inc.
• Legacy Human Services, Inc.
• Legacy Human Services, Inc.

• Skilled Nursing Facility in Henderson, NC
• Providers in Henderson, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2013; 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.