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Organization
LEONARD MANOR INC
Active
Organization
LEONARD 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
902 E HACKBERRY ST, LEONARD, TX 75452-6318
(903) 587-2282
(903) 587-2594
Mailing address
902 E HACKBERRY ST, LEONARD, TX 75452-6318
(903) 587-2282
(903) 587-2594
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
112350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001012164
—
TX
01
—
1893166-01
TEXAS MEDICAID PART B
TX
01
—
HH322S
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
09/27/2005
Last updated
08/28/2008
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