Organization
LEGACY HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY J BRUMMER (ADMINISTRATOR)
(515) 961-5245
Entity
Organization
Contact information
Practice address
207 E SALEM AVE, INDIANOLA, IA 50125-2621
(515) 961-5245
Mailing address
7740 LARABEE ST, INDIANOLA, IA 50125-7101
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
910498
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0896761
—
IA
Enumeration date
01/05/2007
Last updated
01/30/2013
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