Organization
LEGACY TREATMENT CENTER
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
3824 BARRETT DR, SUITE 310, RALEIGH, NC 27609-7220
(954) 560-5238
(888) 510-9071
Mailing address
4421 STUART ANDREW BLVD, SUITE 106, CHARLOTTE, NC 28217-1589
(954) 560-5238
(888) 510-9071
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
MHL-060-1265
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34D2054739
CLIA
NC
01
—
MHL-060-1265
NC STATE LICENSE
NC
Enumeration date
10/07/2014
Last updated
10/07/2014
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