# LEGACY HEALTHCARE CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverwood Healthcare and Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780737692
- **Authorized official:** DOUGLAS K MITTLEIDER (PRESIDENT OF MANAGEMENT COMPANY)
- **Authorized official phone:** (770) 619-0866

## Contact information

- **Practice address:** 600 BACON ST, MADISONVILLE, TX 77864-2511
- **Practice address phone:** (936) 348-9097
- **Practice address fax:** (936) 348-9212
- **Mailing address:** 600 BACON ST, MADISONVILLE, TX 77864-2511
- **Mailing address phone:** (936) 348-9097
- **Mailing address fax:** (936) 348-9212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 116849 | TX | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 07/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5342 | — | TX |