NPIMap

Organization Active NPI

Legacy Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Raleigh, NC
National Provider Identifier
1700289642
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
MHL-060-1265 Issued in NC
Legal business name
LEGACY TREATMENT CENTER
Practice address
3824 Barrett Dr
Suite 310
Raleigh, NC 27609-7220
Phone
(954) 560-5238
Fax
(888) 510-9071
NPI assigned
Oct 7, 2014
Last updated
Oct 7, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
LEGACY TREATMENT CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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 MHL-060-1265 NC Primary

Addresses

Primary practice location

3824 Barrett Dr
Suite 310
Raleigh, NC 27609-7220

Mailing address

4421 Stuart Andrew Blvd
Suite 106
Charlotte, NC 28217-1589
Phone (954) 560-5238

Other identifiers 2

IdentifierTypeStateIssuer
MHL-060-1265OtherNCNC STATE LICENSE
34D2054739OtherNCCLIA

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

4421 Stuart Andrew Blvd
Ste 106
Charlotte, NC 28217

3824 Barrett Dr
Ste 310
Raleigh, NC 27609
Phone (704) 337-5052

NPI Registry JSON

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1700289642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4421 STUART ANDREW BLVD",
            "address_2": "SUITE 106",
            "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": "3824 BARRETT DR",
            "address_2": "SUITE 310",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097220",
            "telephone_number": "954-560-5238",
            "fax_number": "888-510-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY TREATMENT CENTER",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "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": "NC",
            "license": "MHL-060-1265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC STATE LICENSE",
            "identifier": "MHL-060-1265",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34D2054739",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.