Organization
LEGACY HEALTHCARE CORPORATION
Active
Other names
Riverwood Healthcare and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS K MITTLEIDER (PRESIDENT OF MANAGEMENT COMPANY)
(770) 619-0866
Entity
Organization
Contact information
Practice address
600 BACON ST, MADISONVILLE, TX 77864-2511
(936) 348-9097
(936) 348-9212
Mailing address
600 BACON ST, MADISONVILLE, TX 77864-2511
(936) 348-9097
(936) 348-9212
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
116849
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5342
—
TX
Enumeration date
01/22/2007
Last updated
07/08/2008
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