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Organization

LEGACY LIVING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RANDY DUKE DOTSON (OWNER/OPERATOR)
(620) 387-0005
Entity
Organization

Contact information

Practice address
445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
(620) 856-2756
Mailing address
445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
(620) 856-2756

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
B011004
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
818
ADULT CARE OPERATOR
KS
01
B011004
HOME PLUS
KS
Enumeration date
11/08/2017
Last updated
11/08/2017
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