# SOUTHWEST LTC - BONNER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy at Jacksonville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033772413
- **Authorized official:** RONALD PAYNE (PRESIDENT)
- **Authorized official phone:** (469) 916-6100

## Contact information

- **Practice address:** 810 BELLAIRE ST, JACKSONVILLE, TX 75766-9045
- **Practice address phone:** (903) 589-5300
- **Mailing address:** 5560 TENNYSON PKWY STE 210, PLANO, TX 75024-3582
- **Mailing address phone:** (469) 916-6100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2019
- **Last updated:** 04/21/2019