Organization
LEGACY RESIDENTIAL PROGRAM
Active
Organization
LEGACY RESIDENTIAL PROGRAM
Active
Other names
House of Lilies
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ASHLEY EDWARDS RN (CEO)
(215) 397-7823
Entity
Organization
Contact information
Practice address
2156 N 30TH ST, PHILADELPHIA, PA 19121-1101
(267) 315-5124
(267) 324-3106
Mailing address
8480 LIMEKILN PIKE PH 5, WYNCOTE, PA 19095-2816
(267) 315-5124
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366151854
—
DE
05
—
1386342533
—
PA
Enumeration date
05/11/2023
Last updated
05/11/2023
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