NPIMap

Organization Active NPI

Legacy Ohio

  • Substance Abuse Rehabilitation Facility
  • Grandview Heights, OH
National Provider Identifier
1295127314
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
13786 Issued in OH
Legal business name
LEGACY OHIO
Practice address
751 Northwest Blvd
Suite 200-1
Grandview Heights, OH 43212-3856
Phone
(954) 560-5238
Fax
(888) 510-9071
NPI assigned
Feb 26, 2015
Last updated
Feb 26, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
LEGACY TREATMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Authorized official

Name
Brad Wilkerson
Title
Ceo
Phone
(954) 560-5238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 13786 OH Primary

Addresses

Primary practice location

751 Northwest Blvd
Suite 200-1
Grandview Heights, OH 43212-3856

Mailing address

4421 Stuart Andrew Blvd
Suite 608
Charlotte, NC 28217-1589
Phone (954) 560-5238

National Provider Directory

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

Other organizations with this tax ID 6

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

Locations

751 Northwest Blvd
Ste 2001
Grandview Heights, OH 43212

NPI Registry JSON

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1295127314",
    "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",
            "telephone_number": "954-560-5238",
            "fax_number": "888-510-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 NORTHWEST BLVD",
            "address_2": "SUITE 200-1",
            "city": "GRANDVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "432123856",
            "telephone_number": "954-560-5238",
            "fax_number": "888-510-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY OHIO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY TREATMENT CENTER",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "WILKERSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-560-5238"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OH",
            "license": "13786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandview Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.