# LIVING LEGACY HEALTH LLC

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

## Provider details

- **NPI number:** 1891487997
- **Authorized official:** DR. JOHN RUDOLPH DO (OWNER)
- **Authorized official phone:** (208) 503-3113

## Contact information

- **Practice address:** 7717 PADDOCK LN, LEWISTON, ID 83501-6291
- **Practice address phone:** (208) 503-3113
- **Mailing address:** 2320 THAIN GRADE \# 1016, LEWISTON, ID 83501-4115
- **Mailing address phone:** (208) 503-3113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 05/25/2023
- **Last updated:** 01/02/2024