# LEGACY HEALTHCARE SERVICES, INC.

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

## Provider details

- **NPI number:** 1689840266
- **Authorized official:** MS. KATRINA DENEAN JOHNSON (C.O.T.A.)
- **Authorized official phone:** (903) 557-0746

## Contact information

- **Practice address:** 1517 EDNA LN, LONGVIEW, TX 75602-4915
- **Practice address phone:** (903) 557-0746
- **Mailing address:** 1517 EDNA LN, LONGVIEW, TX 75602-4915
- **Mailing address phone:** (903) 557-0746

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 209900 | TX | Yes |

## Other

- **Enumeration date:** 05/05/2008
- **Last updated:** 05/05/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 209900 | STATE BOARD LICENSE | TX |