Organization
LEGACY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JESSICA BULLOCK COTA/L (COTA/L)
(704) 408-0987
Entity
Organization
Contact information
Practice address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
(919) 424-5080
Mailing address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
7096
NC
Other
Enumeration date
06/29/2011
Last updated
06/29/2011
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