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Organization
KILGORE MANOR INC
Active
Organization
KILGORE MANOR INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
(903) 984-3511
(903) 983-1031
Mailing address
2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
(903) 984-3511
(903) 983-1031
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
112798
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00102185
—
TX
01
—
0220162-01
TEXAS MEDICAID B
TX
01
—
HH2539
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/27/2005
Last updated
08/28/2008
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