Legacy Treatment Center LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Loa, UT
NPI 1609266642 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1609266642
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- License
- 11669 (UT)
- Legal business name
- LEGACY TREATMENT CENTER LLC
- Practice address
- 1764 West Aspen Lane
Loa, UT 84747-0400 - Phone
- (435) 836-2272
- Fax
- (435) 836-2274
- NPI assigned
- Jan 29, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Troy J Faddis, LMFT
- Title
- Clinical Director
- Phone
- (435) 836-2272
Practitioners 6
-
Stephen Kern, LSCSW
-
Madolyn Liebing, M.F.T, PSYCHOLOGIST
-
Josie Ann Oyler, FNP-C
-
Rachel Rollins, ACMHC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2118271 | Legacy Treatment Center | Certificate of waiver | Sep 5, 2026 |
National Provider Directory
Locations
1764 Aspen Rd
Loa, UT 84747
Phone (435) 836-2272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 11669 | UT | Yes |
Addresses
Primary practice location
1764 West Aspen Lane
Loa, UT 84747-0400
Mailing address
PO Box 400
Loa, UT 84747-0400
Phone (435) 836-2272
Other providers in Loa, UT
- Christyn Gerber
- Ashlie Marie Harris
- Juniper Canyon Recovery Center for Women, LLC
- Stephen Kern
- Legacy Outdoor Adventures LLC
- Veronica Malencia
- Michael Andrew Mills
- Taleah Moosman
- Devon Christopher Nanton
- Josie Ann Oyler
All providers in Loa, UT · Substance Abuse Rehabilitation Facility in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.