Organization
LEGACY TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA IACULLO (BILLING DIRECTOR)
(561) 715-9288
Entity
Organization
Contact information
Practice address
4421 STUART ANDREW BLVD, SUITE 608, CHARLOTTE, NC 28217-1589
(561) 715-9288
Mailing address
4421 STUART ANDREW BLVD, SUITE 608, CHARLOTTE, NC 28217-1589
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130037
NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC
Enumeration date
05/30/2013
Last updated
07/11/2013
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