1881085637 NPI number — LEGACY TREATMENT SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881085637 NPI number — LEGACY TREATMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY TREATMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881085637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 PEMBERTON BROWNS MILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBERTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08068-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-288-3067
Provider Business Mailing Address Fax Number:
609-265-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 PEMBERTON BROWNS MILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBERTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08068-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-288-3067
Provider Business Practice Location Address Fax Number:
609-265-1895
Provider Enumeration Date:
02/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
609-267-5656

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  2000030 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)