NPIMap

Organization Active NPI

Legacy Treatment LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Baltimore, MD
National Provider Identifier
1912472473
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
LEGACY TREATMENT LLC
Practice address
4432 Park Heights Ave
Baltimore, MD 21215-6315
Phone
(410) 728-4491
Fax
(410) 728-5729
NPI assigned
Oct 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 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
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

4432 Park Heights Ave
Baltimore, MD 21215-6315

Mailing address

826 Hollins St Unit 1
Baltimore, MD 21201-1004
Phone (973) 558-8514

Other practice location 1

1438 Liberty Rd Ste 3&4
Sykesville, MD 21784-6493
Phone (443) 609-4302

Other practice location 2

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

Other organizations with this tax ID 3

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

Locations

1438 Liberty Rd
Ste 34
Sykesville, MD 21784
Phone (443) 609-4302

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1912472473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 HOLLINS ST UNIT 1",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011004",
            "telephone_number": "973-558-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4432 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156315",
            "telephone_number": "410-728-4491",
            "fax_number": "410-728-5729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1438 Liberty Rd Ste 3&4",
            "address_purpose": "LOCATION",
            "city": "Sykesville",
            "state": "MD",
            "postal_code": "217846493",
            "country_code": "US",
            "telephone_number": "443-609-4302",
            "fax_number": "443-409-4625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8610 Washington Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Jessup",
            "state": "MD",
            "postal_code": "207949499",
            "country_code": "US",
            "telephone_number": "410-824-8149",
            "fax_number": "410-824-8371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "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": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.