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Organization
VIDOR MANOR NURSING HOME INC
Active
Organization
VIDOR MANOR NURSING HOME INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
470 MOORE DR, VIDOR, TX 77662-3843
(409) 769-2454
(409) 769-9324
Mailing address
470 MOORE DR, VIDOR, TX 77662-3843
(409) 769-2454
(409) 769-9324
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
114895
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001013574
—
TX
Enumeration date
10/03/2005
Last updated
06/20/2008
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