# LEONARD MANOR INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Living Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679569370
- **Authorized official:** MRS. JANICE PITA (INSURANCE/MEDICARE)
- **Authorized official phone:** (580) 622-6300

## Contact information

- **Practice address:** 902 E HACKBERRY ST, LEONARD, TX 75452-6318
- **Practice address phone:** (903) 587-2282
- **Practice address fax:** (903) 587-2594
- **Mailing address:** 902 E HACKBERRY ST, LEONARD, TX 75452-6318
- **Mailing address phone:** (903) 587-2282
- **Mailing address fax:** (903) 587-2594

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 112350 | TX | Yes |

## Other

- **Enumeration date:** 09/27/2005
- **Last updated:** 08/28/2008

## 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 |