LEGEND AT JEFFERSON'S GARDEN (NPI# 1982938072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982938072 |
| Entity Type | Organization |
| Organization Name | LEGEND AT JEFFERSON'S GARDEN |
| Practice Address |
15401 N Pennsylvania Ave Edmond OK 73013 |
| Practice Telephone | 4057151717 |
| Practice Fax Number | 4057159017 |
| Mailing Telephone | 4057151717 |
| Mailing Fax Number | 4057159017 |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2009-09-23 |
| Authorized Official Name | MRS. NELDA RANDALL (DIRECTOR) |
| Authorized Official Telephone | 4057151717 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | AL5517-5517 | OK | Residential Treatment Facilities |
| Street Address |
15401 N PENNSYLVANIA AVE |
| City | EDMOND |
| State | OK |
| Zip Code | 73013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073994596 | Abrighterlightresdiential Care Home LLC | Residential Treatment Facility, Physical Disabilities | 2708 S Hemlock Ave, Broken Arrow, OK 74012-0817 | 2015-06-10 |
| 1376848051 | New Generation Therapy, LLC | Residential Treatment Facility, Physical Disabilities | 105 E Pekin Ave, Morris, OK 74445-2233 | 2011-01-11 |
| 1942490297 | Next Step Network | Residential Treatment Facility, Physical Disabilities | 1004 E Highway 54, Guymon, OK 73942-4549 | 2007-08-01 |
| 1669686689 | Micha M Sale | Residential Treatment Facility, Physical Disabilities | 13313 N Meridian Ave Ste D3, Oklahoma City, OK 73120-8316 | 2007-05-09 |
Please comment or provide details below to improve the information on LEGEND AT JEFFERSON'S GARDEN.
| 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.