NPIMap

Organization Active NPI

Legacy Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Charlotte, NC
National Provider Identifier
1053758102
Registry record updated Jul 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
LEGACY TREATMENT CENTER
Practice address
4421 Stuart Andrew Blvd
Suite 608
Charlotte, NC 28217-1589
Phone
(561) 715-9288
NPI assigned
May 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2013

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

Authorized official

Name
Angela Iacullo
Title
Billing Director
Phone
(561) 715-9288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

4421 Stuart Andrew Blvd
Suite 608
Charlotte, NC 28217-1589

Mailing address

4421 Stuart Andrew Blvd
Suite 608
Charlotte, NC 28217-1589

Other identifiers 1

IdentifierTypeStateIssuer
130037OtherNCNORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Provider Directory

National Provider Directory
Tax ID family
Legacy Ohio7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373500800000",
    "number": "1053758102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4421 STUART ANDREW BLVD",
            "address_2": "SUITE 608",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 STUART ANDREW BLVD",
            "address_2": "SUITE 608",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171589",
            "telephone_number": "561-715-9288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-07-11",
        "status": "A",
        "authorized_official_last_name": "IACULLO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "561-715-9288"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES",
            "identifier": "130037",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; 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.