# LEGACY LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063925303
- **Authorized official:** RANDY DUKE DOTSON (OWNER/OPERATOR)
- **Authorized official phone:** (620) 387-0005

## Contact information

- **Practice address:** 445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
- **Practice address phone:** (620) 856-2756
- **Mailing address:** 445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
- **Mailing address phone:** (620) 856-2756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | B011004 | KS | Yes |

## Other

- **Enumeration date:** 11/08/2017
- **Last updated:** 11/08/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 818 | ADULT CARE OPERATOR | KS |
| 01 | — | B011004 | HOME PLUS | KS |