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Organization
LEGACY LIVING
Active
Organization
LEGACY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY DUKE DOTSON (OWNER/OPERATOR)
(620) 387-0005
Entity
Organization
Contact information
Practice address
445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
(620) 856-2756
Mailing address
445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
(620) 856-2756
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
B011004
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
818
ADULT CARE OPERATOR
KS
01
—
B011004
HOME PLUS
KS
Enumeration date
11/08/2017
Last updated
11/08/2017
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