NPIMap

Organization Active NPI

Legacy Treatment LLC

  • Substance Abuse Rehabilitation Facility
  • Jessup, MD
National Provider Identifier
1841765393
Registry record updated Oct 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
LEGACY TREATMENT LLC
Practice address
8610 Washington Blvd
Jessup, MD 20794-9499
Phone
(410) 824-8149
Fax
(410) 824-8371
NPI assigned
Oct 11, 2018
Last updated
Oct 11, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
LEGACY TREATMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2018

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

Authorized official

Name
Lloyd A Wynn
Title
Coo
Phone
(973) 558-8514

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

8610 Washington Blvd
Jessup, MD 20794-9499

Mailing address

8610 Washington Blvd Ste 200
Jessup, MD 20794-9499
Phone (410) 824-8149

National Provider Directory

National Provider Directory
Tax ID family
Legacy Treatment LLC4 organizations share this tax ID, including this one
Part of
Legacy Treatment LLC

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539216000000",
    "number": "1841765393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8610 WASHINGTON BLVD STE 200",
            "city": "JESSUP",
            "state": "MD",
            "postal_code": "207949499",
            "telephone_number": "410-824-8149",
            "fax_number": "410-824-8371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8610 WASHINGTON BLVD",
            "city": "JESSUP",
            "state": "MD",
            "postal_code": "207949499",
            "telephone_number": "410-824-8149",
            "fax_number": "410-824-8371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY TREATMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY TREATMENT LLC",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-11",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "973-558-8514"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jessup, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; 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.