# MASON CONVALESCENT CARE CENTER

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

## Provider details

- **NPI number:** 1780671362
- **Authorized official:** MRS. JANICE PITA (INSURANCE/MEDICARE)
- **Authorized official phone:** (580) 622-6300

## Contact information

- **Practice address:** 110 E COLLEGE STREET, MASON, TX 76856-0107
- **Practice address phone:** (325) 347-6383
- **Practice address fax:** (325) 347-6142
- **Mailing address:** 110 E COLLEGE STREET, PO BOX 1668, MASON, TX 76856-0107
- **Mailing address phone:** (325) 347-6383
- **Mailing address fax:** (325) 347-6142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 113248 | TX | Yes |

## Other

- **Enumeration date:** 09/29/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | HH321S | BLUE CROSS BLUE SHIELD | TX |