Organization
CARSON LEGACY LLC
Active
Organization
CARSON LEGACY LLC
Active
Parent organization
CARSON LEGACY LLC
Other names
Peak Recovery
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARSON LEGACY LLC
Authorized official
PAIGE CARSON (OWNER)
(267) 229-3694
Entity
Organization
Contact information
Practice address
2423 S GEORGIA AVE, CALDWELL, ID 83605-4477
(208) 455-1788
Mailing address
2423 S GEORGIA AVE, CALDWELL, ID 83605-4477
(208) 455-1788
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861963340
—
ID
Enumeration date
01/22/2025
Last updated
01/22/2025
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