Organization
LEGACY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM FLORENE FULTZ LPTA (LPTA)
(336) 307-6056
Entity
Organization
Contact information
Practice address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
(919) 424-5080
Mailing address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
(919) 424-5080
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
2870
NC
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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