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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