Provider Demographics
NPI:1508663907
Name:LEGACY LANE SENIOR LIVING
Entity type:Organization
Organization Name:LEGACY LANE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-494-9033
Mailing Address - Street 1:7000 FRANKLIN BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1865
Mailing Address - Country:US
Mailing Address - Phone:916-494-9033
Mailing Address - Fax:
Practice Address - Street 1:7610 LA MANCHA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3837
Practice Address - Country:US
Practice Address - Phone:564-200-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility