# LEGACY

> 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
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831539824
- **Authorized official:** MRS. JAYME MICHELE BOURGEOIS OTA/L (OCCUPATIONAL THERAPY ASSISTANT)
- **Authorized official phone:** (919) 435-1284

## Contact information

- **Practice address:** 2275 RUIN CREEK RD, HENDERSON, NC 27537-8732
- **Practice address phone:** (252) 492-0066
- **Mailing address:** 2275 RUIN CREEK ROAD, HENDERSON, NC 27537
- **Mailing address phone:** (252) 492-0066

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 5022 | NC | Yes |

## Other

- **Enumeration date:** 07/05/2013
- **Last updated:** 07/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5022 | OTA/L | NC |