Legacy Village Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

TO BE DETERMINED Issued in UT

Legal business name

LEGACY VILLAGE HEALTHCARE LLC

Practice address

5472 S 3200 W
Taylorsville, UT 84129-7804

Phone

(801) 269-0700

Fax

(801) 269-1512

NPI assigned

Mar 24, 2008

Organization subpart

Yes

Parent organization

WESTERN STATES LODGINGAs reported in NPPES

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

Authorized official

Name

Mr. Paul C Fairholm

Title

Managing Member

Phone

(801) 269-0700

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Legacy Village for Rehabilitation & Memory Care Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Skilled nursing facility certification: CCN 465171

Legal name

LEGACY VILLAGE HEALTHCARE LLC

Doing business as

LEGACY VILLAGE TRANSITIONAL REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Dec 21, 2009

Last certification

Aug 30, 2023

Beds

40

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

3251 W 5400 S
Taylorsville, UT 84129-3170

Nursing home name

LEGACY VILLAGE REHABILITATION

Listed as

Legacy Village RehabilitationCCN 465171

Overall star rating

2 of 5

Health inspections

3 of 5

Staffing

1 of 5

Quality measures

4 of 5

Type

Medicare

Ownership

For profit - Partnership

Certified

Dec 21, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4035.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 1

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

• Rachael Stubbs, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Salt Lake City, UT
  • NPI 1568489375

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

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

• Emily Anderson

  • Recreation Therapist
  • Taylorsville, UT
  • NPI 1245083849
  NPD (past)
• Edith A Shepherd, APRN LLC

  • Adult Health Nurse Practitioner
  • Herriman, UT
  • NPI 1134457682
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Trenaisa Nay, APRN-BC,NP

  • Gerontology Nurse Practitioner
  • Provo, UT
  • NPI 1447373451

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1881866499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 ATHERTON DR",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841233470",
            "telephone_number": "801-269-0700",
            "fax_number": "801-269-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5472 S 3200 W",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841297804",
            "telephone_number": "801-269-0700",
            "fax_number": "801-269-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY VILLAGE HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN STATES LODGING",
        "enumeration_date": "2008-03-24",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "FAIRHOLM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "801-269-0700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "UT",
            "license": "TO BE  DETERMINED",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": "TO BE DETERMINED",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800008673001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113661303001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870520717001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870638970001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Village for Rehabilitation & Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abbey Leeflang
• Ashlyn Lefevre
• Bryndie Leff
• Jadelliah Lefotu
• Legacy Medical Group, LLC
• Makaya Legocki
• Mark Lehman, PH.D.
• Thea Leiataua
• Teresa Lejander
• Noheaku Upunahele Leomiti-Moe

• Skilled Nursing Facility in Taylorsville, UT
• Providers in Taylorsville, UT by specialty
• Skilled Nursing Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.