Organization Active NPI

Legacy Sobriety and Recovery LLC

  • Assisted Living Facility (Mental Illness)
  • Milwaukee, WI
National Provider Identifier
1174490536
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
LEGACY SOBRIETY AND RECOVERY LLC
Practice address
2810 W Kilbourn Ave Apt 3
Milwaukee, WI 53208-3501
Phone
(414) 309-3213
Fax
(414) 309-3213
NPI assigned
Oct 21, 2025
Last updated
Oct 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Authorized official

Name
Davida CliftonNPI 1689541872
Title
Owner
Phone
(414) 309-3213

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU
Assisted Living Facility (Mental Illness) 3104A0625X NU Primary
Adult Care Home Facility 311ZA0620X NU
Respite Care 385H00000X NU
In Home Supportive Care Agency 253Z00000X NU

Addresses

Primary practice location

2810 W Kilbourn Ave Apt 3
Milwaukee, WI 53208-3501

Mailing address

2810 W Kilbourn Ave Apt 3
Milwaukee, WI 53208-3501
Phone (414) 309-3213

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1761004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1174490536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 W KILBOURN AVE APT 3",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083501",
            "telephone_number": "414-309-3213",
            "fax_number": "414-309-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 W KILBOURN AVE APT 3",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083501",
            "telephone_number": "414-309-3213",
            "fax_number": "414-309-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SOBRIETY AND RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-21",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "CLIFTON",
        "authorized_official_first_name": "DAVIDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-309-3213"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.