NPIMap

Organization Active NPI

Legacy Outdoor Adventures LLC

  • Substance Abuse Rehabilitation Facility
  • Loa, UT
National Provider Identifier
1245509918
Registry record updated Dec 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
LEGACY OUTDOOR ADVENTURES LLC
Practice address
56 South Main Street
Loa, UT 84747
Phone
(435) 836-2272
Fax
(435) 836-2274
NPI assigned
Dec 23, 2011
Last updated
Dec 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2011

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

Authorized official

Name
Mr. Gilbert Hallows
Title
Executive Director
Phone
(435) 836-2272

Specialties & licenses 1

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

Addresses

Primary practice location

56 South Main Street
Loa, UT 84747

Mailing address

PO Box 400
Loa, UT 84747-0400
Phone (435) 836-2272

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1324598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324598400000",
    "number": "1245509918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "LOA",
            "state": "UT",
            "postal_code": "847470400",
            "telephone_number": "435-836-2272",
            "fax_number": "435-836-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 SOUTH MAIN STREET",
            "city": "LOA",
            "state": "UT",
            "postal_code": "84747",
            "telephone_number": "435-836-2272",
            "fax_number": "435-836-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY OUTDOOR ADVENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-23",
        "last_updated": "2011-12-23",
        "status": "A",
        "authorized_official_last_name": "HALLOWS",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-836-2272",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loa, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2011; 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.