Legacy House LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

910498 Issued in IA

Legal business name

LEGACY HOUSE LLC

Practice address

207 E Salem Ave
Indianola, IA 50125-2621

Phone

(515) 961-5245

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Cindy J Brummer

Title

Administrator

Phone

(515) 961-5245

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359504000000",
    "number": "1871640144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7740 LARABEE ST",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501257101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E SALEM AVE",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252621",
            "telephone_number": "515-961-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2013-01-30",
        "status": "A",
        "authorized_official_last_name": "BRUMMER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "515-961-5245",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IA",
            "license": "910498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0896761",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Ruble Kim, PHYSICIAN ASSISTANT
• Teresa Ann Kolarik, ARNP
• Gentry Landers, PHARMD
• Jason Lau, MD
• Katherine Marie Lee, ARNP
• Jerry Lehr, DO
• Megan Lehr
• Ryan Lehr
• Michael Theodore Lindeberg I, DDS
• Long Term Medical Supply Corp

• Adult Care Home Facility in Indianola, IA
• Providers in Indianola, IA by specialty
• Adult Care Home Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.