Organization
AMERICAN LEGACY PROPERTIES LLC
Active
Other names
Legacy Manor Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI PARKINSON (AUTHORIZED REPRESENTATIVE)
(601) 709-1408
Entity
Organization
Contact information
Practice address
1935 N THEOBALD STREET EXT, GREENVILLE, MS 38703-2244
(662) 334-4501
(662) 335-4989
Mailing address
1935 N THEOBALD STREET EXT, GREENVILLE, MS 38703-2244
(662) 334-4501
(662) 335-4989
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
445
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00230142
—
MS
01
—
87080
BLUE CROSS BLUE SHIELD
MS
Enumeration date
05/04/2006
Last updated
04/30/2013
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