Organization
VIDOR MANOR NURSING HOME INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
470 MOORE DR, VIDOR, TX 77662-3843
(409) 769-2454
(409) 769-9324
Mailing address
470 MOORE DR, VIDOR, TX 77662-3843
(409) 769-2454
(409) 769-9324
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
114895
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001013574
—
TX
Enumeration date
10/03/2005
Last updated
06/20/2008
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