Organization
LEGACY HEALTHCARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATRINA DENEAN JOHNSON (C.O.T.A.)
(903) 557-0746
Entity
Organization
Contact information
Practice address
1517 EDNA LN, LONGVIEW, TX 75602-4915
(903) 557-0746
Mailing address
1517 EDNA LN, LONGVIEW, TX 75602-4915
(903) 557-0746
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
209900
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209900
STATE BOARD LICENSE
TX
Enumeration date
05/05/2008
Last updated
05/05/2008
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