LEGACY LIVING (NPI# 1063925303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063925303 |
| Entity Type | Organization |
| Organization Name | LEGACY LIVING |
| Practice Address |
445 E 10th St Baxter Springs KS 66713-1614 |
| Practice Telephone | 6208562756 |
| Mailing Telephone | 6208562756 |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-11-08 |
| Authorized Official Name | RANDY DUKE DOTSON (OWNER/OPERATOR) |
| Authorized Official Telephone | 6203870005 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
B011004 | KS | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | ADULT CARE OPERATOR | 818 | 01 |
| KS | HOME PLUS | B011004 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LEGACY LIVING | 640 N 13th Ave, Elgin, OR 97827 |
| System for Award Management (SAM) Entities | LEGACY LIVING AND REHAB CENTER, THE | 1000 S Douglas Hwy, Gillette, WY 82716-4974 |
| Virginia Business Entities | Legacy Living Inc. | 4808 Courthouse St Ste 104, Williamsburg, Virginia 23188-2684 |
| Colorado Business Entities | Legacy Living LLC | 303 East 17th Ave, Suite 600, Denver, CO 80203 |
| Oklahoma Business Registrations | LEGACY LIVING, L.L.C. | 6606 Lupton Drive, Dallas, TX 75225 |
| Street Address |
445 E 10TH ST |
| City | BAXTER SPRINGS |
| State | KS |
| Zip Code | 66713-1614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588601843 | Tyson L. Burden | Internal Medicine | 445 E 10th St, Baxter Springs, KS 66713-1614 | 2006-06-02 |
| 1134437411 | Crystal Marie Taylor | Nurse Practitioner | 445 E 10th St, Baxter Springs, KS 66713-1614 | 2010-09-20 |
| 1366680126 | Burden Medical Clinic LLC | Clinic/Center | 445 E 10th St, Baxter Springs, KS 66713-1614 | 2009-01-30 |
| 1962438457 | St. John's Medical Group | Clinic/Center | 445 E 10th St, Baxter Springs, KS 66713-1614 | 2006-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144266859 | James C Eaton | Family Medicine | 322 E 11th St, Baxter Springs, KS 66713 | 2006-06-21 |
| 1376637157 | Cherokee County Ambulance Assoc. Dist. IIi | Ambulance | 311 Military Avenue, Baxter Springs, KS 66713-0137 | 2006-10-03 |
| 1629465109 | Monarch Pharmacy | Pharmacy | 1111 Military Ave, Baxter Springs, KS 66713-1509 | 2015-04-22 |
| 1154875714 | Kelly Barnes | Pharmacist | 1111 Military Ave, Baxter Springs, KS 66713-1509 | 2016-08-11 |
| 1457392888 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1000 Military Ave, Baxter Springs, KS 66713-1547 | 2006-06-09 |
| 1417569930 | Carissa Christie | Pharmacist | 1000 Military Ave, Baxter Springs, KS 66713-1547 | 2020-08-17 |
| 1376791335 | Spring Valley Regional Center for Youth, Inc. | Private Vehicle | 217 E 14th St, Baxter Springs, KS 66713-1804 | 2008-09-03 |
| 1477786721 | Baxter Springs Usd508 | Local Education Agency (LEA) | 1520 Cleveland Ave, Baxter Springs, KS 66713-1840 | 2009-09-02 |
| 1053423905 | Wolkar Drug Inc | Pharmacy | 1920 Military Ave, Baxter Springs, KS 66713-2039 | 2006-08-31 |
| 1689288391 | Brian Douglas Caswell | Pharmacy | 1920 Military Ave, Baxter Springs, KS 66713-2039 | 2020-09-01 |
| Find all providers in zip 66713 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558971648 | Tracy Delois Allen | Custodial Care Facility | 2734 N Wellesley Ave, Wichita, KS 67220-2408 | 2020-08-04 |
| 1043841174 | Selah Home LLC | Custodial Care Facility | 15834 Sw Butler Rd, Rose Hill, KS 67133-8549 | 2020-01-28 |
| 1881238681 | Goshen Home Care Inc. | Custodial Care Facility | 9939 Foster St, Overland Park, KS 66212-2452 | 2019-11-05 |
| 1952962870 | Harmony House Home Plus LLC | Custodial Care Facility | 400 N Peterson Ave, Wichita, KS 67212-3732 | 2019-06-21 |
| 1508329905 | Karaway LLC | Custodial Care Facility | 1815 Sw Westwood Cir, Topeka, KS 66604-3269 | 2019-04-11 |
| 1023574209 | Unified Care Homes, Inc. | Custodial Care Facility | 5705 E Rockhill, Wichita, KS 67208 | 2019-02-13 |
| 1881175966 | Rl Fountainwood 2 | Custodial Care Facility | 2000 Fountainwood, Hutchinson, KS 67502-2662 | 2018-08-27 |
| 1306335328 | Anthem Overland Park Management, LLC | Custodial Care Facility | 6921 W 81st St, Overland Park, KS 66204-3913 | 2018-05-04 |
| 1518470186 | Rl Dodge City 1 | Custodial Care Facility | 2800 6th Ave, Dodge City, KS 67801-2478 | 2017-11-06 |
| 1801322714 | Ultra Care Home Plus LLC | Custodial Care Facility | 11537 E Harry St, Wichita, KS 67207-6225 | 2017-05-11 |
| Find all providers with the same taxonomy | ||||
| City | BAXTER SPRINGS |
| Zip Code | 66713 |
Please comment or provide details below to improve the information on LEGACY LIVING.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.