# LEGACY HEALTHCARE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Fountains of West County
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699131573
- **Authorized official:** KELLY ANN FIALA MOTR/L (OT/REHAB DIRECTOR)
- **Authorized official phone:** (636) 448-2881

## Contact information

- **Practice address:** 15822 CLAYTON RD, ELLISVILLE, MO 63011-2212
- **Practice address phone:** (636) 220-1681
- **Practice address fax:** (314) 200-4636
- **Mailing address:** 15822 CLAYTON RD, ELLISVILLE, MO 63011-2212
- **Mailing address phone:** (636) 220-1681
- **Mailing address fax:** (314) 200-4636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2005028265 | MO | Yes |

## Other

- **Enumeration date:** 01/08/2016
- **Last updated:** 01/08/2016