Healthcare Provider Details

I. General information

NPI: 1427877216
Provider Name (Legal Business Name): LEGACY HEALING CENTER LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17430 PARTHENIA ST
SHERWOOD FOREST CA
91325-3241
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 185
BOCA RATON FL
33431-4000
US

V. Phone/Fax

Practice location:
  • Phone: 754-333-7963
  • Fax:
Mailing address:
  • Phone: 954-665-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN KENNEDY
Title or Position: CRO
Credential:
Phone: 954-665-0823