R Legacy Inv LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

R LEGACY INV LLC

Doing business as

Beulahland Assisted Living

Practice address

4706 Knottsville Rd
Grafton, WV 26354-7286

Phone

(304) 265-2874

NPI assigned

Jan 19, 2024

Last updated

Jan 19, 2024By 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

Troy K Rickles

Title

Owner

Phone

(304) 669-4829

Specialties & licenses 1

Addresses

Other names 1

• Beulahland Assisted Living Doing business as

Locations

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1861253569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4107 S TAMIAMI TRL # 326",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342935109",
            "telephone_number": "304-669-4829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4706 KNOTTSVILLE RD",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263547286",
            "telephone_number": "304-265-2874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R LEGACY INV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "RICKLES",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-669-4829"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beulahland Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Grafton, WV
• Providers in Grafton, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.