NPIMap

Organization Active NPI

Legacy Residential Program

Doing business as House of Lilies

  • Case Management Agency
  • Philadelphia, PA
National Provider Identifier
1003506171
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
LEGACY RESIDENTIAL PROGRAM
Doing business as
House of Lilies
Practice address
2156 N 30TH St
Philadelphia, PA 19121-1101
Phone
(267) 315-5124
Fax
(267) 324-3106
NPI assigned
May 11, 2023
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ashley Edwards, RNNPI 1366151854
Title
Ceo
Phone
(215) 397-7823

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU Primary
Assisted Living Facility (Mental Illness) 3104A0625X NU
Intellectual Disabilities Intermediate Care Facility 315P00000X NU
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X NU
Mental Illness Community Based Residential Treatment Facility 320800000X NU
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X NU
Psychiatric Residential Treatment Facility 323P00000X NU
Substance Abuse Rehabilitation Facility 324500000X NU

Addresses

Primary practice location

2156 N 30TH St
Philadelphia, PA 19121-1101

Mailing address

8480 Limekiln Pike PH 5
Wyncote, PA 19095-2816
Phone (267) 315-5124

Other identifiers 2

IdentifierTypeStateIssuer
1366151854MedicaidDE
1386342533MedicaidPA

Other names 1

  • House of Lilies Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1003506171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8480 LIMEKILN PIKE PH 5",
            "city": "WYNCOTE",
            "state": "PA",
            "postal_code": "190952816",
            "telephone_number": "267-315-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2156 N 30TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191211101",
            "telephone_number": "267-315-5124",
            "fax_number": "267-324-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY RESIDENTIAL PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-397-7823",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366151854",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386342533",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "House of Lilies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.