| NPI | 1396114054 |
|---|---|
| Doing Business As | LEGACY ON 10TH AVENUE |
| Entity Type | Organization |
| Authorized Contact | ISAAC DOLE Manager 312-724-8950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |