Organization
LEGACY LODGE AT JACKSON HOLE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON HARNISCH (VP OF FINANCE)
(402) 753-6101
Entity
Organization
Contact information
Practice address
3000 W BIG TRAIL DR, JACKSON, WY 83001-9138
(307) 734-0500
Mailing address
2230 N SOMERS AVE, FREMONT, NE 68025-2515
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
WY
Enumeration date
01/04/2017
Last updated
01/04/2017
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