NPIMap

Organization Active NPI

Legacy Treatment LLC

  • Addiction (Substance Use Disorder) Counselor
  • Baltimore, MD
National Provider Identifier
1952877219
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
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 15, 2018
Organization subpart
Yes
Parent organization
LEGACY TREATMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

4432 Park Heights Ave
Baltimore, MD 21215-6315

Mailing address

4432 Park Heights Ave
Baltimore, MD 21215-6315
Phone (410) 728-4491

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.

Locations

4432 Park Heights Ave
Baltimore, MD 21215
Phone (410) 542-8130

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": "1539561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539561600000",
    "number": "1952877219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": [],
    "basic": {
        "organization_name": "LEGACY TREATMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY TREATMENT LLC",
        "enumeration_date": "2018-10-15",
        "last_updated": "2018-10-15",
        "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": 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 15, 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.