Organization
LEGACY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS PRATHER (EXECUTIVE DIRECTOR)
(719) 275-2917
Entity
Organization
Contact information
Practice address
1335 BAUER LN, CANON CITY, CO 81212-4670
(719) 275-2917
(719) 269-8354
Mailing address
1335 BAUER LANE, CANON CITY, CO 81212
(719) 275-2917
(719) 269-8354
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04182119
—
CO
Enumeration date
04/16/2007
Last updated
08/22/2020
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