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Organization

LEGACY OHIO

Active
Parent organization
LEGACY TREATMENT CENTER
Organization subpart
Yes

Provider details

NPI number
Legal business name
LEGACY TREATMENT CENTER
Authorized official
BRAD WILKERSON (CEO)
(954) 560-5238
Entity
Organization

Contact information

Practice address
751 NORTHWEST BLVD, SUITE 200-1, GRANDVIEW HEIGHTS, OH 43212-3856
(954) 560-5238
(888) 510-9071
Mailing address
4421 STUART ANDREW BLVD, SUITE 608, CHARLOTTE, NC 28217-1589
(954) 560-5238
(888) 510-9071

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
13786
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13786
OHIO DEPT OF MENTAL HEALTH & ADDICTION SERVICES LICENSE
OH
Enumeration date
02/26/2015
Last updated
02/26/2015
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