Basic Information
| Provider Information | |||||||||
| NPI: | 1407177603 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEGACY CARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WATER OAK MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1189 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285631189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331143 | ||||||||
| FaxNumber: | 2526330422 | ||||||||
| Practice Location | |||||||||
| Address1: | 3407 OAKS RD | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285602718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331143 | ||||||||
| FaxNumber: | 2526330422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 06/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2526331143 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL025030 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.