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LEGENDS PARK LLC NPI 1154458354


NPI Information

NPI: 1154458354
Provider Name: LEGENDS PARK LLC

Doing Business As: LEGENDS PARK ASSISTED LIVING COMMUNITY

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 13D2011402

Address:
1820 W GOLF COURSE RD
COEUR D ALENE, ID
ZIP 83815
Phone: (208) 666-9900
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LEGENDS PARK LLC is an assisted living facility in Coeur D Alene, ID. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. LEGENDS PARK LLC NPI is 1154458354. The provider is registered as an organization entity type.
The provider Is Doing Business As Legends Park Assisted Living Community.

The provider's business location address is:

1820 W GOLF COURSE RD
COEUR D ALENE, ID
ZIP 83815-627
Phone: (208) 666-9900
Fax: (208) 765-6587

The provider's authorized official is Gregory J Vislocky .
The authorized official title is Managing Member and has the following contact phone number (360) 735-7155.

The CLIA number assigned to this NPI record is 13D2011402 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/27/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1310400000XAssisted Living FacilityRC 548IDAHOYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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