NPIMap

Organization Active NPI

Legacy Health and Wellness, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1003507500
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
LEGACY HEALTH AND WELLNESS, LLC
Practice address
2921 N Tenaya Way Ste 128
Las Vegas, NV 89128-1411
Phone
(702) 978-8000
NPI assigned
May 16, 2023
Organization subpart
Yes
Parent organization
LEGACY HEALTH AND WELLNESS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Authorized official

Name
Abby Grossa
Title
Cfo
Phone
(702) 395-5011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

2921 N Tenaya Way Ste 128
Las Vegas, NV 89128-1411

Mailing address

2921 N Tenaya Way Ste 128
Las Vegas, NV 89128-1411
Phone (702) 978-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140618000244 NV Part B Supplier - Clinic/Group Practice 9335363118 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Legacy Health and Wellness2 organizations share this tax ID, including this one
Part of
Legacy Health and Wellness

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

911 N Buffalo Dr
Unit 213
Las Vegas, NV 89128
Phone 7029421774 ext. 106

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1003507500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 N TENAYA WAY STE 128",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281411",
            "telephone_number": "702-978-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 N TENAYA WAY STE 128",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281411",
            "telephone_number": "702-978-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY HEALTH AND WELLNESS, LLC",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "GROSSA",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "702-395-5011"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.