Organization
LEGACY1864, LLC
Active
Other names
Willow Grove
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN KNUDSON (CEO/PRESIDENT)
(509) 954-6919
Entity
Organization
Contact information
Practice address
1620 E MEAD ST, SPOKANE, WA 99218-1772
(509) 467-1135
(509) 468-7906
Mailing address
PO BOX 1438, MEAD, WA 99021-1438
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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