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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