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KILGORE MANOR INC NPI 1447246145


NPI Information

NPI: 1447246145
Provider Name: KILGORE MANOR INC

Doing Business As: LEGACY LIVING CENTERS

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization
Address:
2700 S HENDERSON BLVD
KILGORE, TX
ZIP 75662
Phone: (903) 984-3511
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KILGORE MANOR INC is a nursing facility intermediate care facility in Kilgore, TX. The provider is 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. KILGORE MANOR INC NPI is 1447246145. The provider is registered as an organization entity type.
The provider Is Doing Business As Legacy Living Centers.

The provider's business location address is:

2700 S HENDERSON BLVD
KILGORE, TX
ZIP 75662-033
Phone: (903) 984-3511
Fax: (903) 983-1031

The provider's authorized official is Janice Pita .
The authorized official title is Insurance/medicare and has the following contact phone number (580) 622-6300.

The enumeration date for this NPI number is 9/27/2005 and was last updated on 8/28/2008.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility112798TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10220162-01OTHERTEXASTEXAS MEDICAID B
267-5814MEDICARE ID-TYPE UNSPECIFIEDTEXASMEDICARE TEXAS
3HH2539OTHERTEXASBLUE CROSS BLUE SHIELD
400102185MEDICAIDTEXAS

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: 5/5/2024

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