Organization
LEGACY MEDICAL SOLUTIONS LLC
Active
Organization
LEGACY MEDICAL SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MYRON MISSOURI (OWNER)
(443) 854-1646
Entity
Organization
Contact information
Practice address
10631 WENNINGTON ST, BALTIMORE, MD 21220-3151
(443) 854-1646
Mailing address
10631 WENNINGTON ST, BALTIMORE, MD 21220-3151
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
Other
Enumeration date
10/27/2023
Last updated
10/27/2023
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