KILGORE MANOR INC (NPI# 1447246145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447246145 |
| Entity Type | Organization |
| Organization Name | KILGORE MANOR INC |
| Other Organization Name | LEGACY LIVING CENTERS |
| Practice Address |
2700 S Henderson Blvd Kilgore TX 75662-4033 |
| Practice Telephone | 9039843511 |
| Practice Fax Number | 9039831031 |
| Mailing Telephone | 9039843511 |
| Mailing Fax Number | 9039831031 |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2008-08-28 |
| Authorized Official Name | MRS. JANICE PITA (INSURANCE/MEDICARE) |
| Authorized Official Telephone | 5806226300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 112798 | TX | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TEXAS MEDICAID B | 0220162-01 | 01 |
| TX | BLUE CROSS BLUE SHIELD | HH2539 | 01 |
| TX | 00102185 | 05 |
| Other Name | Type Code |
|---|---|
| Legacy Living Centers | Doing Business As Name - Organization |
| Street Address |
2700 S HENDERSON BLVD |
| City | KILGORE |
| State | TX |
| Zip Code | 75662-4033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689130569 | C.m. Speaks, N.p., Pllc | Nurse Practitioner | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2019-02-15 |
| 1922589563 | Angela Matthews Almanza | Occupational Therapy Assistant | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2018-08-22 |
| 1053892604 | Tashata Re'kal Jackson | Occupational Therapy Assistant | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2018-08-22 |
| 1013498666 | Curtis Evans | Physical Therapy Assistant | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2018-08-22 |
| 1538679931 | Mpd Texas Resources of Kilgore LLC | Skilled Nursing Facility | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2017-10-11 |
| 1083011787 | Kilgore Healthcare LLC | Skilled Nursing Facility | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2014-11-24 |
| 1992021661 | Kilgore I Enterprises, LLC | Skilled Nursing Facility | 2700 S Henderson Blvd, Kilgore, TX 75662-4033 | 2010-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346890621 | Linda Gail Watson | Technician | 190 Glendale St, Kilgore, TX 75662 | 2019-09-18 |
| 1174185151 | Jennifer Darlene Franks | Registered Nurse | 6144 Gateway Center Pmb # 320, Kilgore, TX 75662 | 2019-07-01 |
| 1215363312 | Kilgore Integrated Health Pllc | Chiropractor | 726 Us Highway 259 N, Kilgore, TX 75662 | 2013-09-20 |
| 1407172240 | Jeffrey Alan Davis | Specialist/Technologist | 300 N. Kilgore Street, Kilgore, TX 75662 | 2010-04-19 |
| 1396923777 | Rachel Thunder Rose Wyatt | Physical Therapist | 1200 Dudley Road, Kilgore, TX 75662 | 2008-02-07 |
| 1346313673 | Brookshire Grocery Company | Pharmacy | 747 Hwy 259 North, Attention Pharmacy Dept, Kilgore, TX 75662 | 2006-11-16 |
| 1417026451 | Jeffery John Pinkerton | Optometrist | 800 Highway 259 North, Kilgore, TX 75662 | 2006-11-06 |
| 1831205004 | Joseph Claude De Graffenried Jr. | Dentist | 238 Lawrence St, Kilgore, TX 75662 | 2006-08-21 |
| 1235159500 | Charles Robert Cottier | Chiropractor | 316 Henderson, Kilgome, TX 75662 | 2006-07-20 |
| 1346509494 | Kelton Hospice, Inc. | Hospice Care, Community Based | 1100 Stone Road, Suite 269, Kilgore, TX 75662 | 2012-05-10 |
| Find all providers in zip 75662 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649353814 | Gregg Home for The Aged, Inc | Nursing Facility/Intermediate Care Facility | 144 Fm 1252 W, Kilgore, TX 75662-5093 | 2006-10-23 |
| 1598011710 | Pine Hills Health Center, LLC | Nursing Facility/Intermediate Care Facility | 144 Fm 1252 W, Kilgore, TX 75662-5093 | 2012-07-25 |
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| 1225402753 | West Wharton County Hospital District | Nursing Facility/Intermediate Care Facility | 248 Wisteria Ln, El Campo, TX 77437-2545 | 2015-11-20 |
| 1447635040 | Sarah Padlan I | Nursing Facility/Intermediate Care Facility | 3808 Veterans Blvd, Studio 6, Del Rio, TX 78840-2859 | 2015-07-23 |
| 1902289358 | Fnu Anushree | Nursing Facility/Intermediate Care Facility | 328 Bedford Rd Apt 247, Bedford, TX 76022-8032 | 2015-07-02 |
| 1699154278 | Royal Manor Care Center, Inc. | Nursing Facility/Intermediate Care Facility | 4545 S Buckner Blvd, Dallas, TX 75227-4207 | 2015-05-28 |
| Find all providers with the same taxonomy | ||||
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| 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.