# THE LEGACY AT PARK VIEW

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

## Provider details

- **NPI number:** 1679560932
- **Authorized official:** KIMBERLE B DOTY (ADMINISTRATOR)
- **Authorized official phone:** (620) 356-3331

## Contact information

- **Practice address:** 510 E SAN JACINTO AVE, ULYSSES, KS 67880-2241
- **Practice address phone:** (620) 356-3331
- **Practice address fax:** (620) 356-1932
- **Mailing address:** 510 E SAN JACINTO AVE, ULYSSES, KS 67880-2241
- **Mailing address phone:** (620) 356-3331
- **Mailing address fax:** (620) 356-1932

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N034001 | KS | Yes |

## Other

- **Enumeration date:** 10/03/2005
- **Last updated:** 10/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100108710-B | — | KS |