Active NPI
Legacy Wellness LLC
- Substance Use Disorder Rehabilitation Clinic/Center
- Edmond, OK
National Provider Identifier
1104735596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center
- Legal business name
- LEGACY WELLNESS LLC
- Practice address
- 609 S Kelly Ave BLDG F
Edmond, OK 73003-5659 - Phone
- (949) 522-1469
- NPI assigned
- Sep 2, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dolton Beckstead
- Title
- Cfo
- Phone
- (949) 522-1469
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Primary |
Addresses
Primary practice location
609 S Kelly Ave BLDG F
Edmond, OK 73003-5659
Mailing address
609 S Kelly Ave BLDG F
Edmond, OK 73003-5659
Phone (949) 522-1469
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788307200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788307200000",
"number": "1104735596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 S KELLY AVE BLDG F",
"city": "EDMOND",
"state": "OK",
"postal_code": "730035659",
"telephone_number": "949-522-1469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 S KELLY AVE BLDG F",
"city": "EDMOND",
"state": "OK",
"postal_code": "730035659",
"telephone_number": "949-522-1469"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY WELLNESS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-02",
"last_updated": "2026-09-02",
"certification_date": "2026-09-02",
"status": "A",
"authorized_official_last_name": "BECKSTEAD",
"authorized_official_first_name": "DOLTON",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "949-522-1469"
},
"taxonomies": [
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.