Organization
LEGACY RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADELL ELLIS (EXECUTIVE DIRECTOR)
(225) 300-8091
Entity
Organization
Contact information
Practice address
168 W WASHINGTON ST, BATON ROUGE, LA 70802-7655
(225) 300-8091
(225) 302-7462
Mailing address
168 W WASHINGTON ST, BATON ROUGE, LA 70802-7655
(225) 300-8091
(225) 302-7462
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
507
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
507
STATE LICENSE NUMBER
LA
Enumeration date
09/25/2012
Last updated
09/25/2012
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