# VIDOR MANOR NURSING HOME INC

> 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:** Legacy Living Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982691226
- **Authorized official:** JANICE PITA (INSURANCE/MEDICARE)
- **Authorized official phone:** (580) 622-6300

## Contact information

- **Practice address:** 470 MOORE DR, VIDOR, TX 77662-3843
- **Practice address phone:** (409) 769-2454
- **Practice address fax:** (409) 769-9324
- **Mailing address:** 470 MOORE DR, VIDOR, TX 77662-3843
- **Mailing address phone:** (409) 769-2454
- **Mailing address fax:** (409) 769-9324

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 114895 | TX | Yes |

## Other

- **Enumeration date:** 10/03/2005
- **Last updated:** 06/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001013574 | — | TX |